Afleveringen
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Obesity is associated with acute kidney injury in ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention: A national representative cohort study
Catheter Cardiovasc Interv . 2024 May;103(6):897-908. doi: 10.1002/ccd.31030
Abstract
Background: Acute kidney injury (AKI) is a frequentand potentially life-threatening complication after percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction(STEMI). However, the relationship between obesity and the risk of AKI in this specific patient population has not been previously examined.
Methods: We queried the National Inpatient Sample(2016-2019) using ICD-10 codes to obtain a sample of adults with STEMI undergoing PCI. All patients were further subcategorized into obese and nonobese cohorts. The primary outcome was the incidence of AKI. Multivariate regression analysis was performed to assess the impact of obesity on AKI. The consistency of this correlation between subgroups was investigated usingsubgroup analysis and interaction testing.
Results: A total of 62,599 (weighted nationalestimate of 529,016) patients were identified, of which 9.80% (n = 6137) had AKI. Obesity comprised 19.78% (n = 1214) of the AKI cohort. Obese patients wereon average younger, male, white, and had more comorbidities. Additionally, there was a significant positive association between obesity and AKI incidence(adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.15-1.34), which was more pronounced in female patients (aOR: 1.56, 95% CI: 1.33-1.82, p < 0.001, p-interaction = 0.008). The AKI incidence in these patientsincreased steadily during the 4-year study period, and it was consistently higher in obese patients than in nonobese patients (p-trend < 0.001 for all).
Conclusions: Obesity was independently associatedwith a greater risk of AKI among adults with STEMI undergoing PCI, particularly in female patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding theaccuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. Youshould not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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Management of Severe Mitral Regurgitation in Patients With Acute Myocardial Infarction: JACC Focus Seminar 2/5
J Am Coll Cardiol . 2024 May 7;83(18):1799-1817. doi:10.1016/j.jacc.2023.09.840
Abstract
Severe acute mitral regurgitation after myocardialinfarction includes partial and complete papillary muscle rupture or functional mitral regurgitation. Although its incidence is <1%, mitral regurgitation after acute myocardial infarction frequently causes hemodynamic instability, pulmonary edema, and cardiogenic shock. Medical management has the worst prognosis, and mortality has not changed in decades. Surgery represents the gold standard, but it is associated with high rates of morbidity and mortality. Recently, transcatheter interventions have opened a new door for management that may improve survival. Mechanical circulatory support restores vital organ perfusion and offers the opportunity for a steadier surgical repair. Thisreview focuses on the diagnosis and the interventional management, both surgical and transcatheter, with a glance on future perspectives to enhance patientmanagement and eventually decrease mortality.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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Zijn er afleveringen die ontbreken?
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Tolerability and effectiveness of beta-blockers in patients with cardiac amyloidosis: A systematic review and meta-analysis
Int J Cardiol . 2024 May 1:402:131813. doi:10.1016/j.ijcard.2024.131813
Abstract
Objective: This systematic review aimed to assess thetolerability of patients with cardiac amyloidosis (CA) to beta-blockers (BBs) and evaluate its association with adverse outcomes.
Methods: We performed a comprehensive search fromJanuary 1, 2000 to October 20, 2023. Studies examining BB use and tolerance or the relationship between BB use and outcomes in patients with CA were included. Pooled adjusted hazard ratios (aHRs) for all-cause mortality were calculated using random- and fixed-effects models.
Results: Eight observational studies involving 4002patients with CA (87.5% with transthyretin CA [ATTR-CA] and 12.5% with immunoglobulin light chain CA [AL-CA]) were assessed. BBs were used by 52.5% of the patients.However, 26.3% of the patients discontinued BBs because of hypotension, bradycardia, or fatigue. Regarding the association between BB use and all-causedeath, four studies were identified that included 2874 patients with ATTR-CA and 16 patients with AL-CA. The meta-analysis revealed no apparent relationship between BB use and all-cause mortality (pooled aHR = 0.78, 95% confidence interval (CI) = 0.40-1.51). Two studies on patients with ATTR-CA found no impact of BB use on all-cause mortality in the subgroup with left ventricular ejection fraction (LVEF) > 40%, but conflicting results exist for those with LVEF ≤40% (pooled aHR = 0.78, 95% CI = 0.40-1.54).
Conclusion: The limited number of observationalstudies that predominantly enrolled patients with ATTR -CA showed that BBs were used in almost half of the patients with CA, with varying tolerability. However, no significant association was observed between BB use and all-cause mortality.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomized, placebo-controlled, double-blind clinical trial
Randomized Controlled Trial Lancet . 2024 May 11;403(10439):1866-1878. doi: 10.1016/S0140-6736(24)00473-2.
Abstract
Background: Following percutaneous coronaryintervention with stent placement to treat acute coronary syndromes, international clinical guidelines generally recommend dual antiplatelet therapywith aspirin plus a P2Y12 receptor inhibitor for 12 months to prevent myocardial infarction and stent thrombosis. However, data on single antiplatelet therapy with a potent P2Y12 inhibitor earlier than 12 months afterpercutaneous coronary intervention for patients with an acute coronary syndrome are scarce. The aim of this trial was to assess whether the use of ticagrelor alone, compared with ticagrelor plus aspirin, could reduce the incidence of clinically relevant bleeding events without an accompanying increase in major adverse cardiovascular or cerebrovascular events (MACCE).
Methods: In this randomized, placebo-controlled,double-blind clinical trial, patients aged 18 years or older with an acute coronary syndrome who completed the IVUS-ACS study and who had no major ischaemic orbleeding events after 1-month treatment with dual antiplatelet therapy were randomly assigned to receive oral ticagrelor (90 mg twice daily) plus oral aspirin (100 mg once daily) or oral ticagrelor (90 mg twice daily) plus a matching oral placebo, beginning 1 month and ending at 12 months after percutaneous coronary intervention (11 months in total). Recruitment took place at 58 centres in China, Italy, Pakistan, and the UK. Patients were required to remain event-free for 1 month on dual antiplatelet therapy following percutaneous coronary intervention with contemporary drug-eluting stents.Randomisation was done using a web-based system, stratified by acute coronary syndrome type, diabetes, IVUS-ACS randomisation, and site, using dynamicminimisation. The primary superiority endpoint was clinically relevant bleeding (Bleeding Academic Research Consortium [known as BARC] types 2, 3, or 5). Theprimary non-inferiority endpoint was MACCE (defined as the composite of cardiac death, myocardial infarction, ischaemic stroke, definite stent thrombosis, orclinically driven target vessel revascularisation), with an expected event rate of 6·2% in the ticagrelor plus aspirin group and an absolute non-inferiority margin of 2·5 percentage points between 1 month and 12 months afterpercutaneous coronary intervention. The two co-primary endpoints were tested sequentially; the primary superiority endpoint had to be met for hypothesistesting of the MACCE outcome to proceed. All principal analyses were assessed in the intention-to-treat population.
Findings: Between Sept 21, 2019, and Oct 27, 2022, 3400 (97·0%) of the 3505 participants in the IVUS-ACS study were randomly assigned (1700 patients toticagrelor plus aspirin and 1700 patients to ticagrelor plus placebo). 12-month follow-up was completed by 3399 (>99·9%) patients. Between month 1 and month 12 after percutaneous coronary intervention, clinically relevant bleeding occurred in 35 patients (2·1%) inthe ticagrelor plus placebo group and in 78 patients (4·6%) in the ticagrelor plus aspirin group (hazard ratio [HR] 0·45 [95% CI 0·30 to 0·66]; p<0·0001). MACCE occurred in 61 patients (3·6%) in the ticagrelor plus placebo group and in 63 patients (3·7%) in the ticagrelor plus aspirin group (absolute difference -0·1% [95% CI -1·4% to 1·2%]; HR 0·98 [95% CI 0·69 to 1·39];pnon-inferiority<0·0001, psuperiority=0·89).
Interpretation: In patients with an acute coronary syndrome who had percutaneous coronary intervention with contemporary drug-eluting stents and remained event-free for 1 month on dual antiplatelet therapy,treatment with ticagrelor alone between month 1 and month 12 after the intervention resulted in a lower rate of clinically relevant bleeding and a similar rate of MACCE compared with ticagrelor plus aspirin. Along with the results from previous studies, these findings show that most patients in this population can benefit from superior clinical outcomes with aspirin discontinuation and maintenance on ticagrelor monotherapy after 1 month of dual antiplatelet therapy.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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The application value of Metoprolol combined with Dagalizin in enhancing cardiac function and ventricularremodeling in patients with acute myocardial infarction after percutaneous coronary intervention.
J Clin Emerg, 2024, 25(4): 170-174. doi:10.13201/j.issn.1009-5918.2024.04.003
Abstract
To discuss the application value of metoprolol combined with daglizin in improving cardiac function and ventricular remodeling in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).
A total of 86 patients with acute myocardial infarction I- percutaneous coronary intervention from January 2022 to October 2023 were selected and divided into experimental group(43 cases) and control group(43 cases) according to a random table. Patients in the control group were given metoprolol + conventional treatment and patients in the experimental group were given combined treatment with daglizin on this basis. The cardiac function(left ejection fraction[LVEF], heart index[CI], stroke output[SV]), ventricular remodeling(left ventricular end-diastolic volume[LVEDV], left ventricularend-systolic volume[LVESV], left ventricular end-diastolic diameter[LVEDD]) and laboratory parameters(N-terminal B-type natriuretic peptideprecursor[NT-proBNP], hypersensitive C-reactive protein[hs-CRP], interleukin-6[IL-6]), adverse cardiovascular events and adverse events were compared between the two groups.
After treatment, the left ejection fraction, heart index and stroke output of the two groups were significantly higher than those before treatment, and the left ejection fraction, heart index and stroke output in the experimental group were significantly higher than those in the control group(P < 0.05). After treatment, the Left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular end-diastolic diameter,N-terminal B-type natriuretic peptide precursor, hypersensitive C-reactive protein and interleukin-6of the two groups were significantly lower than those before treatment, and Left ventricular end-diastolic volume, left ventricular end-systolic volume, leftventricular end-diastolic diameter, N-terminal B-type natriuretic peptide precursor, hypersensitive C-reactive protein and interleukin-6in the experimental group were significantly lower than those in the control group(P < 0.05). The incidence of adverse cardiovascular events in the experimental group was significantly lower than that in the control group(P < 0.05). The adverse events rate of the two groups was basically the same(P>0.05).
Metoprolol combined with daglizin can improve cardiacfunction and ventricular remodeling in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention(PCI), which is beneficial for prognosis improvement, and it is worthy of clinical promotion.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website
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Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients withacute myocardial infarction
PLoS One . 2024 Apr 4;19(4):e0300578. doi:10.1371/journal.pone.0300578
Abstract
To maintain efficient myocardial function, optimalcoordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated toimprove left ventricular (LV) function. This study aimed to investigate the impact of cardiac rehabilitation on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) werecalculated from the stroke volume and brachial systolic blood pressure. Effective left ventricular end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation(CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the cardiac rehabilitation program and were subsequently classified as the non- cardiac rehabilitation group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P =0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467;P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), andLV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the cardiac rehabilitation group. Changes in E' velocitywere significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and ventricular-arterial mismatch were associated with a negative impact on both left ventricular diastolic and systolic function. The outpatient cardiac rehabilitation program effectively decreased aortic afterload and improved left ventricular diastolic and systolic dysfunction in patients with acute myocardial infarction and preserved or mildly reduced Ejection Fraction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website
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Prognostic Impact of Early Administration of β-Blockers in Critically Ill Patients with Acute Myocardial Infarction
J Clin Pharmacol . 2024 Apr;64(4):410-417.doi: 10.1002/jcph.2370.
Abstract
In critically ill patients with acute myocardialinfarction (AMI), the relationship between the early administration of β-blockers and the risks of in-hospital and long-term mortality remains controversial. Furthermore, there are conflicting evidences for the efficacy of the early administration of intravenous followed by oral β-blockers in acute myocardial infarction. We conducted a retrospective analysis of critically ill patients with acute myocardial infarction who received the early administration of β-blockers within 24 hours of admission. The data were extracted from the Medical Information Mart for Intensive Care IV database. We enrolled 2467 critically ill patients with AMI in the study, with 1355 patients who receivedthe early administration of β-blockers and 1112 patients who were non-users. Kaplan-Meier survival analysis and Cox proportional hazards models showed that the earlyadministration of β-blockers was associated with a lower risk of in-hospital mortality (adjusted hazardratio [aHR] 0.52; 95% confidence interval [95%CI] 0.42-0.64), 1-year mortality (aHR 0.54, 95%CI 0.47-0.63), and 5-year mortality (aHR 0.60, 95%CI0.52-0.69). Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. The risks of in-hospital and long-term mortality were significantly decreased in patients who underwent revascularization with the early administration of β-blockers. We found thatthe early administration of β-blockers could lower the risks of in-hospital and long-term mortality. Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. Notably, patients who underwent revascularization with the early administration of β-blockers showed the lowest risks of in-hospital and long-term mortality.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website
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Ticagrelor was associated with lower fracture risk than clopidogrel in the dual anti-platelet regimen among patients with acute coronary syndrome treated with percutaneous coronary intervention
J Endocrinol Invest. 2024 Apr;47(4):895-902.doi: 10.1007/s40618-023-02205-1
Abstract
Purpose: Patients with coronary artery disease haveincreased fracture risks. P2Y12 inhibitors may impact fracture risks. We compared the fracture risks associated with ticagrelor and clopidogrel in dualanti-platelet therapy (DAPT).
Methods: We identified all adults who underwentfirst-ever percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) between 2010 and 2017 from a territory-wide PCI registry in Hong Kong.Following 1:1 propensity-score matching for baseline characteristics, patients were followed up till event occurrence, death, or 30 June 2022. Outcomes ofinterest were major osteoporotic fractures (MOF) identified by validated ICD-9-CM codes. Cox proportional hazards regression was used to compute the hazard ratio (HR) for major osteoporotic fractures associated with ticagrelor versus clopidogrel use.
Results: 3018 ticagrelor users and 3018 clopidogrel users were identified after propensity-score matching (mean age: 61.4 years; 84.1% men). Upon median follow-up of 6.5 years, 59 ticagrelor users and 119 clopidogrel users sustained major osteoporotic fractures (annualized fracture risks: 0.34 % and 0.56%, respectively).Ticagrelor use was associated with lower risks of major osteoporotic fractures (HR 0.60, 95%CI 0.44-0.83; p =0.002). Consistent hazard ratios were observed for fractures over vertebrae, hip and upper limbs. Subgroup analyses showed no interaction according to age, sex, presence of diabetes, presence of chronic kidney disease and prior fracture history.
Conclusion: Among adults who underwent first-ever percutaneous coronary intervention for acute coronary syndrome, ticagrelor use in the dual anti-platelet therapy was associated with a lower risk of major osteoporoticfractures compared with clopidogrel. Our results support the use of ticagrelor in the dual anti-platelet therapy from the perspective of bone health.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the informationon this website
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2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.
J Am Coll Cardiol 2024;Mar 8:[Epub ahead of print].
In line with recent evidence and guidelines, therecommended core guideline-directed medical therapy (GDMT) for chronic heart failure (HF) includes an angiotensin II receptor/neprilysin inhibitor (ARNI), evidence-based beta-blocker, sodium-glucose cotransporter (SGLT) inhibitor, and mineralocorticoid antagonist (MRA). When feasible, early and rapid initiation of these therapies and titration to maximally tolerated doses within 3 months is recommended. While no specific order of initiation or titration of guideline-directed medical therapy is mandated, the following is some useful guidance a)Start with low doses of core therapies.
b) Delay beta-blocker initiation until HF is compensated.
c) ARNIs and SGLT inhibitors may reduce diuretic needs.
d) MRA and SGLT inhibitors may have minimal BP effects.
e) Mild declines in eGFR don't always require medicationcessation.
Difficulties with adherence to recommended HF therapies can be multifactorial. Effective strategies to improve adherence should be targeted to individual patient needs. Strategies include patient education,simplification of overall medication regimen, reduction of cost and access barriers, medication reminders, utilization of clinical pharmacist, and cognitive behavioral therapies. In addition to managing cardiovascular (CV) comorbidities, attention should be paid to addressing non-CV comorbidities that impact HF outcomes such as diabetes, chronic kidney disease, sleep-disorderedbreathing, iron deficiency, and viral infections (prevention with vaccination).
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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Myocardial infarction drives trainedimmunity of monocytes, accelerating atherosclerosis
Eur Heart J . 2024 Mar 1;45(9):669-684.
Abstract
Background and aims: Survivors of acute coronarysyndromes face an elevated risk of recurrent atherosclerosis-related vascular events despite advanced medical treatments. The underlying causes remainunclear. This study aims to investigate whether myocardial infarction -induced trained immunity in monocytes could sustain proatherogenic traits and expedite atherosclerosis.
Methods: Apolipoprotein-E deficient (ApoE-/-) miceand adoptive bone marrow transfer chimeric mice underwent MI or myocardial ischaemia-reperfusion (IR). A subsequent 12-week high-fat diet (HFD) regimenwas implemented to elucidate the mechanism behind monocyte trained immunity. In addition, classical monocytes were analysed by flow cytometry in the blood of enrolled patients.
Results: In MI and IR mice, blood monocytes and bonemarrow-derived macrophages exhibited elevated spleen tyrosine kinase (SYK), lysine methyltransferase 5A (KMT5A), and CCHC-type zinc finger nucleicacid-binding protein (CNBP) expression upon exposure to a HFD or oxidized LDL (oxLDL) stimulation. MI induced trained immunity was transmissible by transplantation of bone marrow to accelerateatherosclerosis in naive recipients. KMT5A specifically recruited monomethylation of Lys20 of histone H4 (H4K20me) to the gene body of SYK and synergistically transactivated SYK with CNBP. In vivo small interfering RNA (siRNA) inhibition of KMT5A or CNBP potentially slowed post-MI atherosclerosis. Sympathetic denervation with 6-hydroxydopamine reduced atherosclerosis and inflammation after MI. Classical monocytes from STEMI patients withadvanced coronary lesions expressed higher SYK and KMT5A gene levels.
Conclusions: The findings underscore the crucial roleof monocyte trained immunity in accelerated atherosclerosis after myocardial infarction, implying that spleen tyrosine kinase in blood classical monocytesmay serve as a predictive factor for the progression of atherosclerosis in STEMI patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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P2Y12 Inhibitor Monotherapy vs DualAntiplatelet Therapy After Deployment of a Drug-Eluting Stent: The SHARE Randomized Clinical Trial
JAMA Netw Open. 2024 Mar 4;7(3):e240877
Abstract
Importance: P2Y12 inhibitor monotherapy after dualantiplatelet therapy (DAPT; a P2Y12 inhibitor plus aspirin) for a brief duration has recently emerged as an attractive alternative for patients undergoing percutaneous coronary intervention with a drug-eluting stent.
Objective: To investigate whether P2Y12 inhibitormonotherapy after 3 months of DAPTwas noninferior to 12 months of DAPT following percutaneous coronary intervention with a drug-eluting stent.
Design, setting, and participants: The Short-TermDual Antiplatelet Therapy After Deployment of Bioabsorbable Polymer Everolimus-Eluting Stent (SHARE) open-label, noninferiority randomized clinicaltrial was conducted from December 15, 2017, toDecember 14, 2020. Final 1-year clinical follow-up was completed in January 2022. This study was a multicenter trial that was conducted at 20 hospitals inSouth Korea. Patients who underwent successful percutaneous coronary intervention with bioabsorbable polymer everolimus-eluting stents were enrolled.
Interventions: Patients were randomly assigned toreceive P2Y12 inhibitor monotherapy after 3 months of DAPT (n = 694) or 12 months of Dual Antiplatelet Therapy (n = 693).
Main outcomes and measures: The primary outcome was a net adverse clinical event, a composite of major bleeding and major adverse cardiac and cerebrovascular events (cardiac death, myocardial infarction, stentthrombosis, stroke, or ischemia-driven target lesion revascularization) between 3 and 12 months after the index percutaneous coronary intervention. The majorsecondary outcomes were major adverse cardiac and cerebrovascular events and major bleeding. The noninferiority margin was 3.0%.
Results: Of the total 1452 eligible patients, 65patients were excluded before the 3-month follow-up, and 1387 patients were assigned to P2Y12 inhibitor monotherapy or Dual Antiplatelet Therapy Between 3and 12 months of follow-up, the primary outcome occurred in 9 patients in the P2Y12 inhibitor monotherapy group and in 16 patients in the Dual Antiplatelet Therapy group .The major secondaryoutcomes major adverse cardiac and cerebrovascular events occurred in 8 patients in the P2Y12 inhibitormonotherapy group and in 12 patients inthe Dual Antiplatelet Therapy group . Major bleeding occurred in 1 patient in the P2Y12 inhibitor monotherapy group and in 5 patients in the Dual Antiplatelet Therapy group
Conclusions and relevance: In patients with coronaryartery disease undergoing percutaneous coronary intervention with the latest generation of drug-eluting stents, P2Y12 inhibitor monotherapy after 3-month DualAntiplatelet Therapy was not inferior to 12-month Dual Antiplatelet Therapy for net adverse clinical events. Considering the study population and lower-than-expected event rates, further research is required in other populations.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding theaccuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medicaljudgment, which you should exercise in evaluating the information on this website.
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Beta-blocker therapy in heart failurewith preserved ejection fraction (B-HFpEF): A systematic review and meta-analysis
Curr Probl Cardiol. 2024 Mar;49(3):102376
Abstract
Introduction: While beta-blockers are considered thecornerstone of treatment for heart failure with reduced ejection fraction, the same may not apply to patients with heart failure with preserved ejection fraction. To date, the benefit of beta-blockers remains uncertain, and there is no current consensus on their effectiveness. This study sought to evaluate the efficacy of beta-blockers on mortality and rehospitalization among patientswith HFpEF.
Methods: A systematic review and meta-analysis ofrandomized or observational cohort studies examined the efficacy of beta-blocker therapy in comparison with placebo, control, or standard medical care in patients with HFpEF, defined as left ventricular ejection fraction ≥50 %. The main endpoints were mortality (i.e., all-cause and cardiovascular), rehospitalization (i.e., all-cause and for heart failure) and a composite of the two.
Results: Out of the 13,189 records initiallyidentified, 16 full-text records met the inclusion criteria and were analyzed recruiting a total of 27,188 patients. The mean age range was 62-84 years old,predominantly female, with HFpEF in which 63.4 % of patients received a beta-blocker and 36.6 % did not. The pooled analysis of included cohort studies, of variable follow-up durations, showed a significant reduction inall-cause mortality by 19 % whereas rehospitalization for heart failure or its composite with all-cause mortality were similar between the beta-blockerand control groups.
Conclusion : This meta-analysis showed that beta-blocker therapy has the potential to reduce all-causemortality in patients with HFpEF based on observational studies. Nevertheless, it did not affect rehospitalization for heart failure or its composite with all-cause mortality. Large scale randomized trials are needed to clarify thisuncertainty.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding theaccuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. Youshould not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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The efficacy and safety of aspirin-ticagrelor vs. aspirin-clopidogrel in ischemic stroke patients withcerebral artery stenting
Clin Neurol Neurosurg . 2024 Mar 3:239:108229.
Abstract
Objective: First, the efficacy and safety ofaspirin-ticagrelor after cerebral artery stenting in ischemic stroke patients is controversial. Second, there is a gap in the research on guiding twoantiplatelet therapy after stenting based on the CYP2C19 genotype.
Methods: This retrospective study included patientswho underwent cerebral artery stenting at the First Affiliated Hospital of Chongqing Medical University from January 2019 to February 2023. We dividedthem into the aspirin-clopidogrel group and aspirin-ticagrelor group and carefully collected baseline information laboratory data and imaging resultsfrom the patients. The efficacy outcomes were 30 days recurrent stroke, 90 days recurrent stroke, and 180 days recurrent stroke, and the safety outcome wasintracranial hemorrhage. T-tests or Fisher's tests were performed for study outcomes in both groups of patients.
Outcome: A total of 372 patients were included. Forefficacy outcomes, aspirin-ticagrelor was associated with a reduced risk of 180 days recurrent stroke, in patients with CYP2C19 LOF allele and CYP2C19intermediate metabolic genotype compared with aspirin-clopidogrel. There was no significant difference in the rate of intracranial hemorrhage between patientswith aspirin-clopidogrel and aspirin-ticagrelor, regardless of overall, CYP2C19 LOF allele carriers or CYP2C19 intermediate metabolizer. No significant differences were found between the two on other efficacy and safety outcomes.
Conclusion: A cohort study found that aspirin-ticagrelorwas significantly superior to aspirin-clopidogrel in reducing 180 days recurrent stroke in CYP2C19 LOF allele carriers and CYP2C19 intermediatemetabolizers. There was no significant difference between aspirin-ticagrelor and aspirin-clopidogrel in the risk of intracranial hemorrhage in terms of ICHrates.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiacarrest: the FACTOR study
Clin Res Cardiol . 2024 Feb 8. doi: 10.1007/s00392-023-02367-1.
Abstract
Introduction: Acute coronary syndromes (ACS) represent a substantial global healthcare challenge. In its most severe form,it can lead to out-of-hospital cardiac arrest (OHCA). Despite medical advancements, survival rates in OHCA patients remain low. Further, the prediction of outcomes in these patients poses a challenge to all health care providers involved. This study aims at developing a score with variablesavailable on admission to assess in-hospital mortality of patients with OHCA undergoing coronary angiography.
Method: All patients with OHCA due to ACS admitted toa tertiary care center were included. A multivariate logistic regression analysis was conducted to explore the association between clinical variables and in-hospital all-cause mortality. A scoring system incorporating variables available uponadmission to assess individual patients' risk of in-hospital mortality was developed (FACTOR score). The score was then validated.
Results: A total of 291 patients were included in thestudy, with a median age of 65 [56-73] years, including 47 women (16.2%). The in-hospital mortality rate was 41.2%. A prognostic model was developed in the derivation cohort (n = 138) and included the following variables: age, downtime,first detected rhythm, and administration of epinephrine. The area under the curve for the FACTOR score was 0.823 (95% CI 0.737-0.894) in the derivation cohort and 0.828 (0.760-0.891) in the validation cohort (n = 153).
Conclusion: The FACTOR score demonstrated a reliableprognostic tool for health care providers in assessing in-hospital mortality of OHCA patients. Early acknowledgement of a poor prognosis may help in patient management and allocation of resources.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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Factors Associated With Myocardial Infarction in a Rural Population With Peripheral Arterial Diseases
Angiology. 2024 Feb 6:33197241232608. doi:10.1177/00033197241232608.
Abstract
Peripheral arterial disease (PAD) studies in ruralpopulations are limited. The incidence of myocardial infarction (MI) is higher in patients with PAD. This study examined the association between sociodemographic and clinical risk factors and MI in patients with PAD in Central Appalachia, comprising of 230 countries across six states in the United States. Data from electronic medical records of 13,455 patients with PAD were extracted from a large health system in CentralAppalachia. Bivariate and logistic regression analyses were conducted. The final sample consisted of 5574 patients with PAD, of whom 24.85% were also diagnosed with MI. The mean age was 71 ± 11.23 years, and the majority were male (56.40%). After adjusting for confounders, patients with hypertension hadthree times higher odds of MI (adjusted Odds Ratio [aOR] = 3.21; 95% CI: 2.50-4.14) compared with those without hypertension. The likelihood of MI increased by 51% among patients with diabetes (aOR = 1.51; 95% CI: 1.33-1.71),34% among ever-smokers (aOR = 1.34; 95% CI: 1.18-1.52), and 45% in males (aOR = 1.45; 95% CI: 1.27-1.65). Hypertension, diabetes, smoking, and male sex were identified as significant risk factors for MI. Screening and effective management of these risk factors in rural areas could potentially prevent MIincidence among patients with PAD.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on RandomizedTrials Supporting European and American Guideline
Am J Med . 2024 Feb;137(2):137-146.e10. doi:10.1016/j.amjmed.2023.09.021
Abstract
Objective: We aimed to evaluate the applicability ofthe eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries.
Methods: Recommendations provided by American andEuropean guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients.
Results: There were 91.5% patients eligible for betablockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations(69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription ofthe recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving themedications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers).
Conclusion: Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in bothgeneral and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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Ticagrelor versus Clopidogrel in Endovascular therapy for Cerebral Aneurysms: A Systematic Review andMeta-analysis
World Neurosurg . 2024 Feb 9:S1878-8750(24)00210-9
Abstract
Background: Antiplatelet therapy is pivotal inendovascular treatment for intracranial aneurysms. However, there is a lack of studies comparing ticagrelor to clopidogrel in patients with aneurysms undergoing endovascular therapy. Additionally, the existing literature lacks adequate sample size, significant subgrouping, and follow-up, making our studyimportant to cover these gaps.
Methods: We searched five databases to collect allrelevant studies. Categorical outcomes were pooled as relative risk (R.R.) with a 95% confidence interval (CI). In the single-arm meta-analysis, outcomes were pooled as proportions and their corresponding 95% CI.
Results: This comprehensive analysis of 18 studiesinvolving 2,427 patients. For thromboembolic events, the pooled (R.R.) did not show significant differences, whether considering overall events. A similar pattern was observed for thromboembolic events stratified by aneurysmal rupturestatus, with no significant differences in overall events. Hemorrhagic events did not also exhibit significant differences in previously mentionedstratifications. Furthermore, there were no substantial differences in death and mRS (0-2) on discharge between Ticagrelor and Clopidogrel. Single-arm meta-analyses for Ticagrelor demonstrated low rates of thromboembolic events,hemorrhage, death, and favorable mRS scores, with associated confidence intervals. Main line of endovascular treatment did not significantly affect either thromboembolic or hemorrhagic outcomes with Ticagrelor and Clopidogrel.
Conclusion: We found no significant differences inkey outcomes like thromboembolic events, hemorrhagic events, mortality rates, and favorable mRS (0-2) upon discharge in the studied patients between Ticagrelor and Clopidogrel. Moreover, the single-arm meta-analysis for Ticagrelor revealed low rates of thromboembolic events, hemorrhage, mortality,and high rates of favorable mRS scores.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of anyscientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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Predictive value of the thrombotic risk criteria proposed in the 2023 ESC guidelines for the management of ACS: insights from a large PCI registry
Eur Heart J Cardiovasc Pharmacother. 2024 Jan5;10(1):11-19. doi: 10.1093/ehjcvp/pvad069
Abstract
Aim: To assess the value of the thrombotic risk criteria proposed in the 2023 guidelines of the European Society of Cardiology (ESC) for the management of acute coronary syndrome (ACS) to predict the ischaemic risk after percutaneous coronary intervention (PCI).
Methods and results: Consecutive patients with acuteor chronic coronary syndrome undergoing PCI at a large tertiary-care center from 2014 to 2019 were included. Patients were stratified into low, moderate, or high thrombotic risk based on the ESC criteria. The primary endpoint wasmajor adverse cardiovascular events (MACEs) at 1 year, a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included major bleeding. Among 11 787 patients, 2641 (22.4%) were at low-risk, 5286 (44.8%) at moderate risk, and 3860 (32.7%) at high-risk. There was anincremental risk of MACE at 1 year in patients at moderate (hazard ratios (HR) 2.53, 95% confidence interval (CI) 1.78-3.58) and high-risk (HR 3.39, 95% CI 2.39-4.80) as compared to those at low-risk, due to higher rates of all-cause death and MI. Major bleeding rates were increased in high-risk patients (HR1.59, 95% CI 1.25-2.02), but similar between the moderate and low-risk group.The Harrell's C-index for MACE was 0.60.
Conclusion: The thrombotic risk criteria of the 2023ESC guidelines for ACS enable to stratify patients undergoing PCI in categories with an incremental 1 year risk of MACE; however, their overall predictive ability for MACE is modest. Future studies should confirm the value of thesecriteria to identify patients benefiting from an extended treatment with a second antithrombotic agent.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy,adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on thiswebsite.
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Beta-blocker therapy in heart failure with preserved ejection fraction (B-HFpEF): a systematic review and meta-analysis
Curr Probl Cardiol . 2024 Jan 4:102376. doi:10.1016/j.cpcardiol.2024.102376.
Abstract
Introduction: While beta-blockers are considered thecornerstone of treatment for heart failure with reduced ejection fraction, the same may not apply to patients with heart failure with preserved ejection fraction (HFpEF). To date, the benefit of beta-blockers remains uncertain, and there is no current consensus on their effectiveness. This study sought toevaluate the efficacy of beta-blockers on mortality and rehospitalization among patients with HFpEF.
Methods: A systematic review and meta-analysis ofrandomized or observational cohort studies examined the efficacy of beta-blocker therapy in comparison with placebo, control, or standard medical care in patients with HFpEF, defined as left ventricular ejection fraction ≥50%. The main endpoints were mortality (i.e., all-cause and cardiovascular),rehospitalization (i.e., all-cause and for heart failure) and a composite of the two.
Results: Out of the 13,189 records initially identified, 16 full-text records met the inclusion criteria and were analyzedrecruiting a total of 27,188 patients. The mean age range was 62 - 84 years old, predominantly female, with HFpEF in which 63.4% patients received a beta-blocker and 36.6% did not. The pooled analysis of included cohort studies, of variable follow-up durations, showed a significant reduction in all-causemortality by 19% (odds ratio (OR) 0.81; 95% confidence interval (CI): 0.65-0.99, p=0.044) whereas rehospitalization for heart failure (OR 1.13; 95% CI: 0.91-1.41, p=0.27) or its composite with all-cause mortality (OR 1.01; 95% CI: 0.78-1.32, p=0.92) were similar between the beta-blocker and control groups.
Conclusion: This meta-analysis showed that beta-blocker has the potential to reduce all-cause mortality in patients withHFpEF based on observational studies. Nevertheless, rehospitalization for heart failure or its composite with all-cause mortality. Large scale randomized trials are needed to clarify this uncertainty.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute foryour own medical judgment, which you should exercise in evaluating the information on this website
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One year clinical outcome of dual anti-platelet therapy with the Novel Ticagrelor plus Aspirin versus Clopidogrelplus Aspirin for Endovascular Intervention of patients with Intracranial Aneurysm: A meta-analysis
J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107491.
Abstract
Background: The use of stents to treat un-rupturedintracranial aneurysms was first approved in the year 2002 in the United States as a Humanitarian Device Exemption. Antiplatelet therapy is mandatory following stent placement. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrelhas been the first line agents for the prevention of thromboembolic events following neuro-endovascular procedures. However, clopidogrel hypo-responsiveness has often been observed. In this analysis, we aimed tosystematically compare one year clinical outcome of DAPT with the Novel Ticagrelor plus Aspirin versus Clopidogrel plus Aspirin for Endovascular Intervention of patients with Intracranial Aneurysm.
Methods: Online electronic databases were searchedfrom June 2023 till July 2023 for relevant studies which compared DAPT with ticagrelor or clopidogrel for endovascular intervention in patients with intracranial aneurysm. The endpoints which were analyzed were classified into thromboembolic and hemorrhagic events. A fixed and a random effect statistical model were used during data analysis respectively. Risk ratio (RR) with 95 % confidence interval (CI) was used to represent the data following analysis.
Results: Five studies with a total number of 893participants were included in this analysis. Three hundred and fifty eight (358) participants were assigned to the ticagrelor group whereas 535 participants were assigned to clopidogrel group. Participants' enrollment period ranged from the year 2009 to 2019. Our results showed that during a meanfollow-up time period of one year, DAPT with ticagrelor was associated with significantly lower thromboembolic events with RR: 0.33, 95 % CI: 0.16 - 0.68; P = 0.003. In addition, at one year, DAPT with ticagrelor was not associatedwith any increase in hemorrhagic events (RR: 0.66, 95 % CI: 0.29 - 1.50; P = 0.32) when compared to DAPT with clopidogrel.
Conclusion: At one year, DAPT with ticagrelor wasassociated with significantly lower thromboembolic events without any increase in hemorrhagic events when compared to clopidogrel associated DAPT for endovascular intervention of patients with intracranial aneurysm. However, eventhough ticagrelor-associated DAPT use appeared to be more effective and safe, this hypothesis should only be confirmed in larger upcoming trials.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy,adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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