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6 záznamů v Medvik Filtry

Článek

Frequency, clinical and angiographic characteristics, and outcomes of high-risk non-ST-segment elevation acute coronary syndromes patients with left circumflex culprit lesions

Halim, Sharif A
Autor Halim, Sharif A Division of Cardiology and Duke Clinical Research Institute, Durham, NC, USA
Clare, Robert M
Autor Clare, Robert M Division of Cardiology and Duke Clinical Research Institute, Durham, NC, USA
Newby, L Kristin
Autor Newby, L Kristin Division of Cardiology and Duke Clinical Research Institute, Durham, NC, USA. Electronic address: kristin.newby@duke.edu
Lokhnygina, Yuliya
Autor Lokhnygina, Yuliya Division of Cardiology and Duke Clinical Research Institute, Durham, NC, USA
Schweiger, Marc J
Autor Schweiger, Marc J Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA
Hof, Arnoud W
Autor Hof, Arnoud W Division of Cardiology, Hospital 'De Weezenlanden', Isala Klinieken, Zwolle, The Netherlands
Hochman, Judith S
Autor Hochman, Judith S Department of Medicine, New York University School of Medicine, New York, NY, USA
James, Stefan K
Autor James, Stefan K Uppsala University Hospital, Cardiology, Uppsala, Sweden
White, Harvey D
Autor White, Harvey D Green Lane Cardiovascular Service, Auckland, New Zealand
Widimsky, Petr
Autor Widimsky, Petr Third Faculty of Medicine, Charles University, Prague, Czech Republic

International journal of cardiology. 2016 ; 203 (-) : 708-13. [pub] 20151110

Int J Cardiol
ISSN 1874-1754
Medvik
Zdroj

BACKGROUND: The relationship between culprit vessel, infarct size, and outcomes in non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unclear. In some reports, the left circumflex artery (LCX) was more often the culprit at angiography than the right coronary artery (RCA) or left anterior descending artery (LAD), and infarcts were larger with LCX culprits. METHODS: We determined culprit vessel frequency and initial patency (TIMI flow grade), median fold elevation of peak troponin above the upper limit of normal, and outcomes (30-day death or myocardial infarction [MI] and 1-year mortality) by culprit vessel in high-risk NSTE ACS patients in the EARLY ACS trial. RESULTS: Of 9406 patients, 2066 (22.0%) had angiographic core laboratory data. We evaluated 1774 patients for whom the culprit artery was not the left main, a bypass graft, or branch vessel. The culprit was the LCX in 560 (31.6%), LAD in 653 (36.8%), and RCA in 561 (31.6%) patients. There were fewer women (24.1%) and more prior MI (25.5%) among patients with a culprit LCX compared with those with a culprit LAD or RCA. Patients with LCX (21.2%) and RCA (27.5%) culprits more often had an occluded artery (TIMI 0/1) than did those with LAD (11.3%). Peak troponin elevation was significantly higher for LCX than RCA or LAD culprits. LCX culprit vessels were not associated with worse 30-day or 1-year outcomes in adjusted models. CONCLUSIONS: Among patients with NSTE ACS, the frequencies of LCX, LAD, and RCA culprits were similar. Although LCX lesions were associated with higher peak troponin levels, there was no difference in short- or intermediate-term outcomes by culprit artery.

MeSH
akutní koronární syndrom epidemiologie radiografie terapie MeSH
časové faktory MeSH
elektrokardiografie * MeSH
incidence MeSH
inhibitory agregace trombocytů aplikace a dávkování MeSH
intravenózní infuze MeSH
koronární angiografie * MeSH
koronární angioplastika metody MeSH
koronární cévy radiografie chirurgie MeSH
lidé MeSH
míra přežití trendy MeSH
peptidy aplikace a dávkování MeSH
prognóza MeSH
rizikové faktory MeSH
senioři MeSH
trombocytový glykoproteinový komplex IIb-IIIa antagonisté a inhibitory MeSH
výsledek terapie MeSH
Check Tag
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
multicentrická studie MeSH
práce podpořená grantem MeSH
randomizované kontrolované studie MeSH
Research Support, N.I.H., Extramural MeSH
Geografické názvy
Evropa MeSH
Nový Zéland MeSH
Spojené státy americké MeSH

Článek online

Effect of the REG1 anticoagulation system versus bivalirudin on outcomes after percutaneous coronary intervention (REGULATE-PCI): a randomised clinical trial

Lancet. 2016 ; 387 (10016) : 349-56. [pub] 20151105

ISSN 1474-547X
Medvik
Zdroj

BACKGROUND: REG1 is a novel anticoagulation system consisting of pegnivacogin, an RNA aptamer inhibitor of coagulation factor IXa, and anivamersen, a complementary sequence reversal oligonucleotide. We tested the hypothesis that near complete inhibition of factor IXa with pegnivacogin during percutaneous coronary intervention, followed by partial reversal with anivamersen, would reduce ischaemic events compared with bivalirudin, without increasing bleeding. METHODS: We did a randomised, open-label, active-controlled, multicentre, superiority trial to compare REG1 with bivalirudin at 225 hospitals in North America and Europe. We planned to randomly allocate 13,200 patients undergoing percutaneous coronary intervention in a 1:1 ratio to either REG1 (pegnivacogin 1 mg/kg bolus [>99% factor IXa inhibition] followed by 80% reversal with anivamersen after percutaneous coronary intervention) or bivalirudin. Exclusion criteria included ST segment elevation myocardial infarction within 48 h. The primary efficacy endpoint was the composite of all-cause death, myocardial infarction, stroke, and unplanned target lesion revascularisation by day 3 after randomisation. The principal safety endpoint was major bleeding. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, identifier NCT01848106. The trial was terminated early after enrolment of 3232 patients due to severe allergic reactions. FINDINGS: 1616 patients were allocated REG1 and 1616 were assigned bivalirudin, of whom 1605 and 1601 patients, respectively, received the assigned treatment. Severe allergic reactions were reported in ten (1%) of 1605 patients receiving REG1 versus one (<1%) of 1601 patients treated with bivalirudin. The composite primary endpoint did not differ between groups, with 108 (7%) of 1616 patients assigned REG1 and 103 (6%) of 1616 allocated bivalirudin reporting a primary endpoint event (odds ratio [OR] 1·05, 95% CI 0·80-1·39; p=0·72). Major bleeding was similar between treatment groups (seven [<1%] of 1605 receiving REG1 vs two [<1%] of 1601 treated with bivalirudin; OR 3·49, 95% CI 0·73-16·82; p=0·10), but major or minor bleeding was increased with REG1 (104 [6%] vs 65 [4%]; 1·64, 1·19-2·25; p=0·002). INTERPRETATION: The reversible factor IXa inhibitor REG1, as currently formulated, is associated with severe allergic reactions. Although statistical power was limited because of early termination, there was no evidence that REG1 reduced ischaemic events or bleeding compared with bivalirudin. FUNDING: Regado Biosciences Inc.