Nejvíce citovaný článek - PubMed ID 28886622
According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion.
- Klíčová slova
- P2Y12 receptor inhibition, antiplatelet therapy, cangrelor, ticagrelor,
- MeSH
- adenosinmonofosfát * analogy a deriváty terapeutické užití aplikace a dávkování škodlivé účinky MeSH
- akutní koronární syndrom * terapie farmakoterapie diagnóza MeSH
- inhibitory agregace trombocytů * terapeutické užití aplikace a dávkování škodlivé účinky MeSH
- koronární angioplastika * škodlivé účinky MeSH
- lékové interakce MeSH
- lidé MeSH
- purinergní receptory P2Y - antagonisté * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- adenosinmonofosfát * MeSH
- cangrelor MeSH Prohlížeč
- inhibitory agregace trombocytů * MeSH
- purinergní receptory P2Y - antagonisté * MeSH
Acute myocardial infarction is a manifestation of atherosclerosis which may be fatal. In-hospital and short-term mortality rates after an acute myocardial infarction have declined in the past few decades. However, although long-term mortality has decreased, it remains unacceptably high. This review paper summarises the non-pharmacological interventions (smoking cessation, physical activity, nutrition, and psychosocial intervention) and pharmacological approaches (antiplatelet and lipid-lowering therapy, renin-angiotensin-aldosterone system inhibitors, beta-blockers, and glucose-lowering drugs) to secondary prevention after a myocardial infarction. The provision of secondary prevention services is established through cardiac rehabilitation, which consists of several discussed components. Finally, we discuss the quality indicators for long-term care after an acute myocardial infarction.
- Klíčová slova
- cardiovascular rehabilitation, lifestyle, myocardial infarction, pharmacotherapy, secondary prevention,
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
There has been a significant increase in the use of short-term percutaneous ventricular assist devices (pVADs) as acute circulatory support in cardiogenic shock and to provide haemodynamic support during interventional procedures, including high-risk percutaneous coronary interventions. Although frequently considered together, pVADs differ in their haemodynamic effects, management, indications, insertion techniques, and monitoring requirements. This consensus document summarizes the views of an expert panel by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Association for Acute Cardiovascular Care (ACVC) and appraises the value of short-term pVAD. It reviews the pathophysiological context and possible indications for pVAD in different clinical settings and provides guidance regarding the management of pVAD based on existing evidence and best current practice.
- Klíčová slova
- Acute coronary syndromes, ECMO, High-risk percutaneous coronary intervention, Impella, Intra-aortic balloon pump, Mechanical circulatory support,
- MeSH
- hemodynamika MeSH
- intraaortální balónková pumpa MeSH
- kardiogenní šok terapie MeSH
- konsensus MeSH
- koronární angioplastika * MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population. METHODS: Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel. RESULTS: For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age < 65 years, smaller vessels, treatment of ostial and calcified lesions, and in-stent restenosis. CONCLUSION: Within the framework of a post hoc analysis based on a real-world, large cohort study, there were no differences in the combined endpoint of major adverse cardiac events (MACE), bleeding and thrombotic events for clopidogrel and ticagrelor in stable CAD or ACS patients. Despite the recommendation for clopidogrel by the European Society of Cardiology (ESC), real-world ticagrelor use was observed in subgroups of stable CAD patients that ought to be explored in future trials.
- Klíčová slova
- Clopidogrel, Dual antiplatelet therapy, Polymer-free, Sirolimus-eluting stent, Ticagrelor,
- MeSH
- časové faktory MeSH
- dodržování směrnic MeSH
- duální protidestičková léčba * škodlivé účinky mortalita MeSH
- hodnocení rizik MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky MeSH
- kardiovaskulární látky aplikace a dávkování škodlivé účinky MeSH
- koronární angioplastika škodlivé účinky přístrojové vybavení mortalita MeSH
- koronární trombóza etiologie prevence a kontrola MeSH
- krvácení chemicky indukované MeSH
- lékařská praxe - způsoby provádění MeSH
- lidé středního věku MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- nemoci koronárních tepen diagnostické zobrazování mortalita terapie MeSH
- pozorovací studie jako téma MeSH
- protézy - design MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sirolimus aplikace a dávkování škodlivé účinky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- stenty uvolňující léky * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- kardiovaskulární látky MeSH
- sirolimus MeSH
Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.
- Klíčová slova
- Median arcuate ligament syndrome, atherosclerosis, coeliac artery release, mesenteric arteries, mesenteric artery stenting,
- MeSH
- arteriae mesentericae diagnostické zobrazování MeSH
- chronická nemoc epidemiologie terapie MeSH
- CT angiografie MeSH
- gastroenterologie metody normy MeSH
- hodnocení rizik metody MeSH
- kontrastní látky aplikace a dávkování MeSH
- magnetická rezonanční angiografie metody MeSH
- medicína založená na důkazech metody normy MeSH
- mezenteriální ischemie diagnóza epidemiologie terapie MeSH
- mezioborová komunikace MeSH
- radiologie metody normy MeSH
- společnosti lékařské normy MeSH
- stupeň závažnosti nemoci MeSH
- týmová péče o pacienty normy MeSH
- výsledek terapie MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- kontrastní látky MeSH
BACKGROUND: The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS: Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS: Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS: PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.
- MeSH
- etnicita statistika a číselné údaje MeSH
- imunosupresiva terapeutické užití MeSH
- incidence MeSH
- infarkt myokardu epidemiologie prevence a kontrola MeSH
- koronární angioplastika metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nemoci koronárních tepen terapie MeSH
- polymery MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- sirolimus terapeutické užití MeSH
- stenty uvolňující léky * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa epidemiologie MeSH
- Korejská republika epidemiologie MeSH
- Malajsie epidemiologie MeSH
- Středomoří epidemiologie MeSH
- Názvy látek
- imunosupresiva MeSH
- polymery MeSH
- sirolimus MeSH