Coronary artery disease
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Coronary artery disease · May 2014
Second-generation versus first-generation drug-eluting stents for the treatment of patients with acute coronary syndromes and obstructive coronary artery disease.
Randomized trials and registries have shown that drug-eluting stents (DES) have an overall better performance than bare-metal stents in patients treated in the setting of both ST-segment and non-ST-segment elevation acute coronary syndromes, mainly by reducing restenosis. Whether or not the use of newer second-generation devices (vs. first-generation DES) differs in these high-risk patients remains to be determined. ⋯ Our results suggest that both first-generation and second-generation DES seem to be similarly effective in patients undergoing a percutaneous coronary intervention in the setting of acute coronary syndromes. However, newer second-generation devices may offer potential advantages because of a significantly lower incidence of ARC-definite ST.
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Coronary artery disease · Mar 2014
Comparative StudyEffect of sex on recovery of ejection fraction in patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Myocardial necrosis after ST-segment elevation myocardial infarction (STEMI) can cause left ventricular systolic dysfunction, which has been associated with poor outcomes. Some authors have reported that women have higher mortality rates after primary percutaneous coronary intervention (PCI), but differences between the sexes with regard to recovery of ejection fraction (EF) in patients with STEMI receiving primary PCI have not been evaluated. We aimed to assess the effect of sex on EF recovery in patients with anterior wall STEMI after primary PCI. ⋯ These data suggest that being female is an independent determinant of LVEF recovery in patients with anterior myocardial infarction after primary PCI.
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Coronary artery disease · Jan 2014
Attenuated plaque is associated with plaque prolapse accompanied by cardiac enzyme elevation after drug-eluting stent implantation.
This study aimed to evaluate the relationship between grayscale intravascular ultrasound-attenuated plaque (AP) and poststenting plaque prolapse (PP) as well as their influence on creatine kinase-myocardial band (CK-MB) elevation after drug-eluting stent (DES) implantation. ⋯ Baseline AP was associated with high-risk characteristics, higher frequency, and greater volume of poststenting PP accompanied by CK-MB elevation in patients with DES implantation.
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Coronary artery disease · Jan 2014
ReviewDual antiplatelet therapy after drug-eluting stents: defining the proper duration.
As compared with bare-metal stents, drug-eluting stents (DESs) reduce restenosis in every clinical situation and every type of lesion studied. Therefore, DESs have been in widespread use for more than a decade and are used in the majority of patients receiving intracoronary stents. However, several studies have suggested that early discontinuation of dual antiplatelet therapy (DAPT; the combination of aspirin and an inhibitor of platelet P2Y12) is associated with a greater risk for 'late' stent thrombosis in patients with DESs. ⋯ On the basis of recent clinical studies, a shorter course of DAPT than recommended by the guidelines (at least 12 months in the ACCF/AHA/SCAI guideline and 6-12 months in the European Society of Cardiology guidelines) may be considered, especially with second-generation or newer-generation DESs being associated with a significant reduction in stent thrombosis compared with first-generation DES. However, as these trials also had insufficient statistical power to allow for a firm decision with regard to the optimal DAPT duration after DES implantation, the results of larger ongoing clinical trials are necessary to resolve this issue before changing the practice. This article systematically reviews the cumulative evidence from key clinical studies and tries to help guide the physician in making informed decisions on the optimal duration of DAPT for patients who are undergoing DES implantation.