NHLBI-Sponsored Randomized Trial of Postconditioning During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction.

NHLBI-Sponsored Randomized Trial of Postconditioning During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction. Circ Res. 2019 Jan 03;: Authors: Traverse JH, Swingen C, Henry TD, Fox J, Wang Y, Chavez IJ, Lips DL, Lesser JR, Pedersen WR, Burke NM, Pai A, Lindberg JL, Garberich R Abstract RATIONALE: Postconditioning (PostC) at the time of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) may reduce infarct size and improve myocardial salvage. However, clinical trials have shown inconsistent benefit. OBJECTIVE: We performed the first NHLBI-sponsored trial of PostC in the United States utilizing strict enrollment criteria to optimize the early benefits of PostC and assess its long-term effects on LV function. METHODS AND RESULTS: We randomized 122 STEMI patients to PostC (Four, 30-sec. PTCA inflations / deflations) + PCI(n=65) vs. routine PCI (n=57). All subjects had an occluded major epicardial artery (TIMI= 0) with ischemic times between 1 and 6 hours with no evidence of pre-infarction angina or collateral blood flow. Cardiac MRI measured at 2 days post-PCI showed no difference between the PostC group and Control in regards to infarct size (22.5 {plus minus} 14.5 g vs. 24.0 {plus minus} 18.5 g), myocardial salvage index (MSI) (30.3 {plus minus} 15.6% vs. 31.5 {plus minus} 23.6%) or mean LVEF. MRI at 12-months showed a significant recovery of LVEF in both groups (61.0 {p...
Source: Circulation Research - Category: Cardiology Authors: Tags: Circ Res Source Type: research

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CONCLUSION: In real-world patients at high risk of bleeding, implantation of the polymer-free metallic stent coated with Biolimus-A9 (Biofreedom®; Biosensors Europe, Morges, Switzerland) followed by 1 -month DAPT showed encouraging results without any stent thrombosis. PMID: 31965195 [PubMed - as supplied by publisher]
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Publication date: Available online 1 September 2019Source: The LancetAuthor(s): Deepak L Bhatt, Philippe Gabriel Steg, Shamir R Mehta, Lawrence A Leiter, Tabassome Simon, Kim Fox, Claes Held, Marielle Andersson, Anders Himmelmann, Wilhelm Ridderstråle, Jersey Chen, Yang Song, Rafael Diaz, Shinya Goto, Stefan K James, Kausik K Ray, Alexander N Parkhomenko, Mikhail N Kosiborod, Darren K McGuire, Robert A HarringtonSummaryBackgroundPatients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic even...
Source: The Lancet - Category: General Medicine Source Type: research
We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay. PMID: 31066332 [PubMed - as supplied by publisher]
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
Conclusions: In patients who are on OAC with vitamin K antagonist and underwent percutaneous coronary intervention, no significant differences were found in mortality, ischemic, and hemorrhagic complications between the patients treated with TT and DT. Thus, tailored treatment based on individual thromboembolic and bleeding risk might be the most reasonable approach in these patients.
Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Reviews Source Type: research
Authors: You J, Wang X, Wu J, Gao L, Wang X, Du P, Liu H, Li J, Wang Y, Liang Y, Guo W, Zhang Q Abstract Background: We aimed to investigate the predictors and prognosis of left ventricular thrombus (LVT) in patients admitted for post-myocardial infarction (MI) and left ventricular dysfunction after contemporary percutaneous coronary intervention (PCI). Methods: We prospectively enrolled 267 consecutive post-MI patients with left ventricular ejection fraction (LVEF)
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
This study sought to investigate the incidence, management, and clinical relevance of atrial fibrillation (AF) during and after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and evaluate outcomes of different antithrombotic strategies. Background Uncertainty exists regarding the optimal antithrombotic strategy in patients with AF who are undergoing PCI with DES. Methods Using a consecutive series of 10,027 patients who underwent DES implantation between 2003 and 2011, we evaluated the overall prevalence and clinical impact of AF. In addition, we compared the efficacy and safety of dual antiplate...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Authors: Tags: Coronary Source Type: research
Conclusions:Although the frequency of pericarditis, mural hemorrhage and subsequent myocardial rupture after MI is declining following PCI, clinicians should be mindful of this potential complication in tPA treated patients with recent MI. Further, cardiac wall rupture should be considered in patients who develop acute hypotension and bradycardia following tPA administration. The current literature is limited and insufficient to provide generalizable guidance on managing AIS patients with recent MI.Disclosure: Dr. Neu has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Lyerly has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Cerebrovascular Disease Case Reports II Source Type: research
Both hemorrhagic and ischemic cerebrovascular events are rare but serious complications after acute myocardial infarction (MI) and coronary angiography / percutaneous coronary intervention (PCI). The most threatening one is intracranial hemorrhage related to antiplatelet and antithrombotic treatment of acute MI. In up to 10% of patients with acute MI ischemic stroke can result from embolisation of intraventricular or intraatrial thrombi [1]. It may occur within the first 2weeks, but also as early as in the first 24h.
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Conclusions— Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.
Source: Stroke - Category: Neurology Authors: Tags: Percutaneous Coronary Intervention, Intracranial Hemorrhage, Ischemic Stroke Clinical Sciences Source Type: research
Ischemic stroke following acute myocardial infarction (AMI) is a rare but serious complication due to left ventricular thrombus formation and atrial fibrillation. Early revascularization of the culprit coronary lesion is essential. Treatment trends may affect the risk. Conversely, the greater use of antiplatelet agents to reduce the risk of ischemic stroke could increase the risk of hemorrhagic stroke. The risk of stroke after AMI has decreased significantly with more use of percutaneous coronary intervention and antithrombotic therapies in the acute setting, and statins, antihypertensive medications, and dual antiplatelet...
Source: Cardiology Clinics - Category: Cardiology Authors: Source Type: research
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