Background: Despite the current standard antiplatelet regimen of aspirin and clopidogrel (with or without glycoprotein IIb/IIIa inhibitors) in percutaneous coronary intervention patients, periprocedural and postprocedural ischemic events continue to occur. Prasugrel (CS-747, LY640315), a novel potent thienopyridine P2Y(12) receptor antagonist, has the potential to achieve higher levels of inhibition of ADP-induced platelet aggregation than currently approved doses of clopidogrel.
Methods And Results: Joint Utilization of Medications to Block Platelets Optimally-Thrombolysis In Myocardial Infarction 26 (JUMBO-TIMI 26) was a phase 2, randomized, dose-ranging, double-blind safety trial of prasugrel versus clopidogrel in 904 patients undergoing elective or urgent percutaneous coronary intervention. Patients were randomized to either standard dosing with clopidogrel or 1 of 3 prasugrel regimens. Subjects were monitored for 30 days for bleeding and clinical events. The primary end point of the trial was clinically significant (TIMI major plus minor) non-CABG-related bleeding events in prasugrel- versus clopidogrel-treated patients. Hemorrhagic complications were infrequent, with no significant difference between patients treated with prasugrel or clopidogrel in the rate of significant bleeding (1.7% versus 1.2%; hazard ratio, 1.42; 95% CI, 0.40, 5.08). In prasugrel-treated patients, there were numerically lower incidences of the primary efficacy composite end point (30-day major adverse cardiac events) and of the secondary end points myocardial infarction, recurrent ischemia, and clinical target vessel thrombosis.
Conclusions: In this phase 2 study, which was designed to assess safety when administered at the time of percutaneous coronary intervention, prasugrel and clopidogrel both resulted in low rates of bleeding. The results of this trial serve as a foundation for the large phase 3 clinical trial designed to assess both efficacy and safety.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.104.502815 | DOI Listing |
Background: Training in complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) has frequently been reserved for established operators (consultants/attending) with trainees (fellows-in-training or FIT) being often discouraged from carrying out such procedures as a primary operator due to their high-risk nature. Whether the outcomes of these cases differ if the primary operator is a supervised FIT compared with a consultant is unknown.
Methods: Using multicentre PCI data from three cardiac centres in South Wales, UK (2018-2022), we identified 2295 CHIP-PCI cases with a UK-BCIS CHIP Score of 3 or more.
Cardiol Rev
January 2025
Departments of Cardiology and Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY.
Right ventricular myocardial infarction (RVMI) is a significant and distinct form of acute myocardial infarction associated with considerable morbidity and mortality. It occurs most commonly due to proximal right coronary artery obstruction, often in conjunction with inferior myocardial infarction. RVMI poses unique diagnostic and therapeutic challenges due to the anatomical and functional differences between the right and left ventricles.
View Article and Find Full Text PDFCurr Cardiol Rep
January 2025
Division of Cardiology, Louisiana State University Health Sciences Center - Shreveport (LSUHSC-S), 1501 Kings Hwy, Shreveport, LA, 71103, USA.
Purpose Of Review: What is the pathophysiology and clinical findings as well as management of patients presenting with INOCA/MINOCA (Ischemia/Myocardial Infarction with Non-Obstructive Coronary Arteries).
Recent Findings: INOCA/MINOCA has a complex pathophysiology. In this review article, we aim to summarize the complex pathophysiology and clinical diagnosis, and review the current management options.
Vasa
January 2025
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany.
Pulmonary embolism (PE) can result in high mortality. Early risk stratification and treatment are critical for individualized management. In patients with intermediate-high-risk (IHR) PE, guidelines recommend to consider a percutaneous catheter-directed treatment (CDT).
View Article and Find Full Text PDFCardiol Young
January 2025
Pediatric Interventional Cardiology Unit, Autònoma de Barcelona University, Vall d'Hebron Hospital, Barcelona, Spain.
We describe a 12-year-old boy with agenesis of the intrahepatic segment of the inferior vena cava (a rare congenital anomaly) in whom an electrified coronary guidewire with electrocautery was used percutaneously to perforate and open the atretic segment, followed by stent implantation. This technique may be a safe and feasible option for paediatric patients, offering a therapeutic alternative for complex cardiac anatomies.
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