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1. Antithrombotic therapy in patients with acute coronary syndrome: similarities and differences between a European expert consensus document and the 2023 European Society of Cardiology guidelines

Author

Landi, Antonio, Aboyans, Victor, Angiolillo, Dominick J, Atar, Dan, Capodanno, Davide, Fox, Keith A A, Halvorsen, Sigrun, James, Stefan, Jüni, Peter, Leonardi, Sergio, Mehran, Roxana, Montalescot, Gilles, Navarese, Eliano Pio, Niebauer, Josef, Oliva, Angelo, Piccolo, Raffaele, Price, Susanna, Storey, Robert F, Völler, Heinz, Vranckx, Pascal, Windecker, Stephan, and Valgimigli, Marco

Abstract

Antithrombotic therapy represents the cornerstone of the pharmacological treatment in patients with acute coronary syndrome (ACS). The optimal combination and duration of antithrombotic therapy is still matter of debate requiring a critical assessment of patient comorbidities, clinical presentation, revascularization modality, and/or optimization of medical treatment. The 2023 European Society of Cardiology (ESC) guidelines for the management of patients with ACS encompassing both patients with and without ST segment elevation ACS have been recently published. Shortly before, a European expert consensus task force produced guidance for clinicians on the management of antithrombotic therapy in patients with ACS as well as chronic coronary syndrome. The scope of this manuscript is to provide a critical appraisal of differences and similarities between the European consensus paper and the latest ESC recommendations on oral antithrombotic regimens in ACS patients.

Published
2024
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3. Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease

Author

Valgimigli, Marco, Aboyans, Victor, Angiolillo, Dominick, Atar, Dan, Capodanno, Davide, Halvorsen, Sigrun, James, Stefan, Jüni, Peter, Kunadian, Vijay, Landi, Antonio, Leonardi, Sergio, Mehran, Roxana, Montalescot, Gilles, Navarese, Eliano Pio, Niebauer, Josef, Oliva, Angelo, Piccolo, Raffaele, Price, Susanna, Storey, Robert F, Völler, Heinz, Vranckx, Pascal, Windecker, Stephan, and Fox, Keith A A

Abstract

Multiple guidelines and consensus papers have addressed the role of antithrombotic strategies in patients with established coronary artery disease (CAD). Since evidence and terminology continue to evolve, the authors undertook a consensus initiative to guide clinicians to select the optimal antithrombotic regimen for each patient. The aim of this document is to provide an update for clinicians on best antithrombotic strategies in patients with established CAD, classifying each treatment option in relation to the number of antithrombotic drugs irrespective of whether the traditional mechanism of action is expected to mainly inhibit platelets or coagulation cascade. With the aim to reach comprehensiveness of available evidence, we systematically reviewed and performed meta-analyses by means of both direct and indirect comparisons to inform the present consensus document.Graphical AbstractAlgorithm for antithrombotic treatment in patients with established CAD. Treatment preferences within each box are shown from above to below, whereas treatments within the same line are sorted in alphabetical order. Panels A and B refer to non-high bleeding risk (HBR) and HBR patients, respectively. HBR is defined according to the ARC-HBR criteria or a PRECISE-DAPT score ≥25. * for patients at high ischaemic risk and very low bleeding risk. § if the patient is not eligible for above shown treatment options. Box colours indicate composition of antithrombotic regimens (light blue: SAPT; grey: DAPT; and red: DAT). Abbreviations: ARC, Academic Research Consortium; CABG, coronary artery bypass grafting; CAD, coronary artery disease; DAPT, dual antiplatelet therapy; DAT, dual antithrombotic therapy; MI, myocardial infarction; PCI, percutaneous coronary intervention; SAPT, single antiplatelet therapy.

Published
2023
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4. Data standards for transcatheter aortic valve implantation: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart)

Author

Aktaa, Suleman, Batra, Gorav, James, Stefan K, Blackman, Daniel J, Ludman, Peter F, Mamas, Mamas A, Abdel-Wahab, Mohamed, Angelini, Gianni D, Czerny, Martin, Delgado, Victoria, De Luca, Giuseppe, Agricola, Eustachio, Foldager, Dan, Hamm, Christian W, Iung, Bernard, Mangner, Norman, Mehilli, Julinda, Murphy, Gavin J, Mylotte, Darren, Parma, Radoslaw, Petronio, Anna Sonia, Popescu, Bodgan A, Sondergaard, Lars, Teles, Rui C, Sabaté, Manel, Terkelsen, Christian J, Testa, Luca, Wu, Jianhua, Maggioni, Aldo P, Wallentin, Lars, Casadei, Barbara, and Gale, Chris P

Abstract

Graphical AbstractEuroHeart = European Unified Registries for Heart Care Evaluation and Randomised Trials, HRQoL = health-related quality of life, TAVI = transcatheter aortic valve implantation.

Published
2023
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5. A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor Asundexian to Prevent Adverse Cardiovascular Outcomes After Acute Myocardial Infarction

Author

Rao, Sunil V., Kirsch, Bodo, Bhatt, Deepak L., Budaj, Andrzej, Coppolecchia, Rosa, Eikelboom, John, James, Stefan K., Jones, W. Schuyler, Merkely, Bela, Keller, Lars, Hermanides, Renicus S., Campo, Gianluca, Ferreiro, José Luis, Shibasaki, Taro, Mundl, Hardi, Alexander, John H., Hengstenberg, Christian, Steinwender, Clemens, Alber, Hannes, Steringer-Mascherbauer, Regina, Schober, Andreas, Auer, Johann, Roithinger, Franz Xaver, von Lewinski, Dirk, Moertl, Deddo, Huber, Kurt, Coussement, Patrick, Hoffer, Etienne, Beauloye, Christophe, Janssens, Luc, Vranckx, Pascal, De Raedt, Herbert, Vanassche, Thomas, Vrolix, Matthias, Rokyta, Richard, Parenica, Jiri, Pelouch, Radek, Motovska, Zuzanna, Alan, David, Kettner, Jiri, Polasek, Rostislav, Cermak, Ondrej, Sedlon, Pavel, Hanis, Jiri, Novak, Martin, Belohlavek, Jan, Horacek, Thomas, Leggewie, Stefan, Wenzel, Philip, vom Dahl, Juergen, Sievers, Burkhard, Pulz, Jan, Schellong, Sebastian, Clemmensen, Peter, Muller-Hennessen, Matthias, Rassaf, Tienush, Falukozi, Jozsef, Ruzsa, Zoltan, Tomcsanyi, Janos, Csanadi, Zoltan, Herczeg, Bela, Koszegi, Zsolt, Vorobcsuk, Andras, Kiss, Robert, Baranyai, Csaba, Dezsi, Csaba, Merkely, Bela, Lupkovics, Geza, Rossini, Roberta, Scherillo, Marino, Sergio Saba, Pier, Calogero Campo, Gianluca, Calo, Leonardo, Nassiacos, Daniele, Quadri, Giorgio, Sciahbasi, Alessandro, Silvio Marenzi, Gian Carlo, Reimers, Bernhard, Perna, Gian Piero, Sacca, Salvatore, Fattore, Luciano, Brunelli, Claudio, Picchi, Andrea, Kuramochi, Takehiko, Kondo, Kazuhisa, Aoyama, Takahiko, Kudoh, Takashi, Yamamoto, Tadashi, Takaya, Tomofumi, Mukai, Yasushi, Fukui, Kazuki, Morioka, Nobuyuki, Ando, Kenji, Yamamuro, Atsushi, Morita, Yasuhiro, Koga, Yasuaki, Watanabe, Tetsuya, Sakamoto, Tomohiro, Shibasaki, Taro, Maebuchi, Daisuke, Takahashi, Akihiko, Yonetsu, Taishi, Kakuta, Tsunekazu, Nishina, Hidetaka, Oemrawsingh, Rohit, Dorman, Reinhart, Oude Ophius, Ton, Prins, Paco, al Windy, N.Y.Y., Zoet-Nugteren, S.K., Hermanides, Rik, van Eck, Martijn, Scherptong, Roderick, Cornel, J.H., Damman, Peter, Bech, Gerhard, Torquay, R., Kietselaer, Bas, Grzelakowski, Pawel, Krzysztof, Dyrbus, Budaj, Andrzej, Miekus, Pawel, Przybylski, Andrzej, Zarebinski, Maciej, Balsam, Pawel, Szachniewicz, Joanna, Gierlotka, Marek, Tycinska, Agnieszka, Iniguez Romo, Andres, Fernandez Ortiz, Antonio, Carrasquer Cucarella, Anna, Sanmartin Fernandez, Marcelo, Sionis, Alessandro, Bueno Zamora, Hector, Ferreiro Gutierrez, Jose Luis, Almenar, Luis, Ferreira Gonzalez, Ignacio, Pascual Figal, Domingo A., Almendro Delia, Manuel, Jimenez Fernandez, Miriam, Skeppholm, Mika, Zedigh, Crister, Angeras, Oskar, Lauermann, Jorg, Erlinge, David, Gustafsson, Robin, Mooe, Thomas, Utreras, Alejandro, James, Stefan, Grimfjard, Per, Pedrazzini, Giovanni, Mach, Francois, Fournier, Stephane, Haegeli, Laurent, Beer, Jurg H., Leibundgut, Gregor, Kobza, Richard, Kaiser, Christoph, Kunadian, Vijay, Al-Lamee, Rasha, Gorog, Diana, Khan, Sohail, Trevelyan, Jasper, Toor, Iqbal, Smith, James, Purushottam, Bhaskar, Treasure, Charles, Arena, Frank, Vedere, Amarnath, Henderson, David, Gilani, Syed, Jones, Alonzo, Carrillo-Jimenez, Rodolfo, Gillespie, Eve, Marhefka, Gregary, Wang, David, Olson, Charles, Bloom, Stephen, Iftikhar, Faizan, Brabham, David, McGinty, John, Thompson, Charles, Talano, James, Ginete, Wilson, Williams, Marcus, Masud, Ali, Ariani, Mehrdad, Bitar, Fahed, Wang, Thomas, and Samuelson, Bradley

Published
2022
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6. Defining Strategies of Modulation of Antiplatelet Therapy in Patients With Coronary Artery Disease: A Consensus Document from the Academic Research Consortium

Author

Capodanno, Davide, Mehran, Roxana, Krucoff, Mitchell W., Baber, Usman, Bhatt, Deepak L., Capranzano, Piera, Collet, Jean-Philippe, Cuisset, Thomas, De Luca, Giuseppe, De Luca, Leonardo, Farb, Andrew, Franchi, Francesco, Gibson, C. Michael, Hahn, Joo-Yong, Hong, Myeong-Ki, James, Stefan, Kastrati, Adnan, Kimura, Takeshi, Lemos, Pedro A., Lopes, Renato D., Magee, Adrian, Matsumura, Ryosuke, Mochizuki, Shuichi, O’Donoghue, Michelle L., Pereira, Naveen L., Rao, Sunil V., Rollini, Fabiana, Shirai, Yuko, Sibbing, Dirk, Smits, Peter C., Steg, P. Gabriel, Storey, Robert F., ten Berg, Jurrien, Valgimigli, Marco, Vranckx, Pascal, Watanabe, Hirotoshi, Windecker, Stephan, Serruys, Patrick W., Yeh, Robert W., Morice, Marie-Claude, and Angiolillo, Dominick J.

Abstract

Antiplatelet therapy is the mainstay of pharmacologic treatment to prevent thrombotic or ischemic events in patients with coronary artery disease treated with percutaneous coronary intervention and those treated medically for an acute coronary syndrome. The use of antiplatelet therapy comes at the expense of an increased risk of bleeding complications. Defining the optimal intensity of platelet inhibition according to the clinical presentation of atherosclerotic cardiovascular disease and individual patient factors is a clinical challenge. Modulation of antiplatelet therapy is a medical action that is frequently performed to balance the risk of thrombotic or ischemic events and the risk of bleeding. This aim may be achieved by reducing (ie, de-escalation) or increasing (ie, escalation) the intensity of platelet inhibition by changing the type, dose, or number of antiplatelet drugs. Because de-escalation or escalation can be achieved in different ways, with a number of emerging approaches, confusion arises with terminologies that are often used interchangeably. To address this issue, this Academic Research Consortium collaboration provides an overview and definitions of different strategies of antiplatelet therapy modulation for patients with coronary artery disease, including but not limited to those undergoing percutaneous coronary intervention, and consensus statements on standardized definitions.

Published
2023
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7. Nationwide cardiovascular risk categorization: applying the European Society of Cardiology guidelines to the Swedish National Diabetes Register

Author

Eliasson, Björn, Ekelund, Jan, Holmberg, Cecilia Nagorny, Wolden, Michael Lyng, Matthiessen, Kasper Sommer, and James, Stefan

Abstract

Type 2 diabetes, or T2D, causes blood sugar levels to get too high. Nearly one-third of people with T2D also have diseases of the heart and blood vessels, such as heart attacks and strokes. These are known as cardiovascular diseases or events. Some T2D medications can also lower the risk of cardiovascular disease.Using data from national healthcare registries, we looked at how many people with T2D in Sweden had a very high cardiovascular disease risk. Healthcare systems often have limited budgets and may not treat all people with a very high cardiovascular disease risk. So, we looked at ways to identify which patients with T2D would benefit most from treatment. We also estimated how many cardiovascular events may be prevented by giving these patients cardiovascular risk-lowering T2D medication, using a medication called semaglutide as an example.The registry included 348 857 people with T2D, and 91.7% (320 028) were not given cardiovascular risk-lowering T2D medications. Of the people not given medications, 40.5% (129 512) had a very high cardiovascular disease risk. On average, we found that people with a very high cardiovascular disease risk and previous cardiovascular events ended up having more cardiovascular events than those without previous events. People who also regularly had high average blood sugar levels, measured using a marker in the blood called glycated haemoglobin, or HbA1c, had even more cardiovascular events.Giving semaglutide to people with a very high cardiovascular disease risk who have already had a cardiovascular event may prevent around 803 cardiovascular events each year.

Published
2023
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8. Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC)

Author

Navarese, Eliano Pio, Landi, Antonio, Oliva, Angelo, Piccolo, Raffaele, Aboyans, Victor, Angiolillo, Dominick, Atar, Dan, Capodanno, Davide, Fox, Keith A A, Halvorsen, Sigrun, James, Stefan, Jüni, Peter, Kunadian, Vijay, Leonardi, Sergio, Mehran, Roxana, Montalescot, Gilles, Niebauer, Josef, Price, Susanna, Storey, Robert F, Völler, Heinz, Vranckx, Pascal, Windecker, Stephan, and Valgimigli, Marco

Abstract

Graphical AbstractThe two best-in-class treatments for each outcome. Number needed to treat (NNT) and number needed to harm (NNH) with 95% confidence intervals were generated from the within and beyond 12 months network meta-analyses (NMAs) and adjusted according to baseline risk profile (low and high risks). Best-in-class antithrombotic regimens for patients at high and low risk of all-cause mortality, myocardial infarction, stroke, or major bleeding are presented in hierarchical order in terms of net benefit (NNH/NNT ratio). The average follow-up for the within and beyond 12 months NMA was 12 and 30 months, respectively. * denotes statistically significant differences in the NMA.

Published
2023
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9. Randomized Trials Fit for the 21st Century: A Joint Opinion From the European Society of Cardiology, American Heart Association, American College of Cardiology, and the World Heart Federation

Author

Bowman, Louise, Weidinger, Franz, Albert, Michelle A., Fry, Edward T.A., Pinto, Fausto J., Achenbach, Stephan, Bowman, Louise, Casadei, Barbara, Collins, Rory, Devereaux, Philip J., Douglas, Pamela S., Frobert, Ole, Goto, Shinya, Grines, Cindy, Harrington, Robert A., Haynes, Richard, Hochman, Judith S., James, Stefan, Kirchhof, Paulus, Komajda, Michel, Lam, Carolyn S.P., Landray, Martin, Maggioni, Aldo, McMurray, John, Medhurst, Nick, Neal, Bruce, Rydén, Lars, Thiele, Holger, Van Gelder, Isabelle, Wallentin, Lars, Yusuf, Salim, and Zannad, Faiez

Published
2023
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10. Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency

Author

Szymański, Piotr, Weidinger, Franz, Lordereau-Richard, Isabelle, Himmelmann, Anders, Arca, Marcello, Chaves, Jose, Lee, Charles, Jonker, Carla, Kotecha, Dipak, O'Kelly, James, Plueschke, Kelly, Ryś, Andrzej, Segec, Andrej, Wallentin, Lars, Veltrop, Rogier, and James, Stefan

Abstract

Real world data (RWD) refers to healthcare information that is routinely collected in electronic healthcare records (EHR), hospital and pharmacy records, patient and disease registries, and health insurance databases. The collection and analysis of this vast amount of data is an important complement to that obtained from conventional randomised controlled trials (RCT). Real world data has been used for healthcare quality improvements, to conduct clinical trials, to support drug and device development, and to inform medical guidelines. The utility of RWD may be facilitated by common data models, which standardise format and content, and allow data from different health systems to be analysed together.The European Society of Cardiology (ESC) supports the use of RWD in collaboration with national cardiac societies, regulatory authorities, and industry to encourage continuous quality of care improvements at the hospital and country level, to conduct registry-based randomised clinical trials (R-RCT) and to facilitate safety surveillance of novel drugs and devices.The European Medicines Agency (EMA) is developing systems and processes to enable the use of RWD that can help in trial planning, defining clinical contexts, and enhancing outcome assessments. RWD can also contribute to the measurement of the impact of regulatory actions, such as contraindications or restriction of indications by looking at medicines use patterns over time across European Member States. A number of other initiatives from the European Commission and the EMA are underway to strengthen the EU's health security framework, and foster the collection and utilisation of RWD.Graphical AbstractExamples of types of data that can be collected as part of routine care.

Published
2023
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11. Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial

Author

Demidova, Marina M., Rylance, Rebecca, Koul, Sasha, Dworeck, Christian, James, Stefan, Aasa, Mikael, Hamid, Mehmet, Swahn, Eva, Hambraeus, Kristina, Danielewicz, Mikael, Linder, Rikard, Fröbert, Ole, Grimfjärd, Per, Stewart, Jason, Henareh, Loghman, Andersson, Jonas, Wagner, Henrik, Erlinge, David, and Platonov, Pyotr G.

Abstract

Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia.

Published
2023
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12. Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients: PROSPECT II

Author

Gyldenkerne, Christine, Maeng, Michael, Kjøller-Hansen, Lars, Maehara, Akiko, Zhou, Zhipeng, Ben-Yehuda, Ori, Erik Bøtker, Hans, Engstrøm, Thomas, Matsumura, Mitsuaki, Mintz, Gary S., Fröbert, Ole, Persson, Jonas, Wiseth, Rune, Larsen, Alf I., Jensen, Lisette O., Nordrehaug, Jan E., Bleie, Øyvind, Omerovic, Elmir, Held, Claes, James, Stefan K., Ali, Ziad A., Rosen, Hans C., Stone, Gregg W., and Erlinge, David

Published
2023
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13. The need for increased pragmatism in cardiovascular clinical trials

Author

Usman, Muhammad Shariq, Van Spall, Harriette G. C., Greene, Stephen J., Pandey, Ambarish, McGuire, Darren K., Ali, Ziad A., Mentz, Robert J., Fonarow, Gregg C., Spertus, John A., Anker, Stefan D., Butler, Javed, James, Stefan K., and Khan, Muhammad Shahzeb

Abstract

The majority of cardiovascular randomized controlled trials (RCTs) test interventions in selected patient populations under explicitly protocol-defined settings. Although these ‘explanatory’ trial designs optimize conditions to test the efficacy and safety of an intervention, they limit the generalizability of trial findings in broader clinical settings. The concept of ‘pragmatism’ in RCTs addresses this concern by providing counterbalance to the more idealized situation underpinning explanatory RCTs and optimizing effectiveness over efficacy. The central tenets of pragmatism in RCTs are to test interventions in routine clinical settings, with patients who are representative of broad clinical practice, and to reduce the burden on investigators and participants by minimizing the number of trial visits and the intensity of trial-based testing. Pragmatic evaluation of interventions is particularly important in cardiovascular diseases, where the risk of death among patients has remained fairly stable over the past few decades despite the development of new therapeutic interventions. Pragmatic RCTs can help to reveal the ‘real-world’ effectiveness of therapeutic interventions and elucidate barriers to their implementation. In this Review, we discuss the attributes of pragmatism in RCT design, conduct and interpretation as well as the general need for increased pragmatism in cardiovascular RCTs. We also summarize current challenges and potential solutions to the implementation of pragmatism in RCTs and highlight selected ongoing and completed cardiovascular RCTs with pragmatic trial designs.

Published
2022
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15. International Perspectives on the Impact of the COVID-19 Pandemic on Adherence to Prescribed Dual Antiplatelet Therapy: A Window Into Acute Cardiovascular Care

Author

Pollack, Charles V., Steg, P. Gabriel, James, Stefan, Jolly, Sanjit, Kosiborod, Mikhail, and Bonaca, Marc P.

Abstract

An international panel of expert clinicians and researchers in acute cardiac care was convened to review, describe, and contextualize their varied experiences delivering care and maintaining ongoing research during the first year of the COVID-19 pandemic and beyond. A proposed perspective from which care and outcomes could be viewed was the possibility that without routine follow-up and as-accustomed interactions with their care team, patients at risk of acute atherothrombotic events might be less adherent to prescribed antiplatelet medications. This might be manifested by more emergency coronary events or by an increased (and perhaps unidentifiable) incidence of out-of-hospital cardiovascular deaths related to patient anxiety about presenting to hospital during the pandemic. The experiences of the panel members were similar in many regards, which identified opportunities for improvement in cardiac care the next time there is a substantial disruption of usual practice. Regardless of geography or payor system, there was an identified need for better remote care platforms; but stronger infrastructure and consumer facility with remote care technology, improved provider-patient communication to help ensure adherence to primary and secondary prevention medications, and longer-term prescription fills and no-hassle refills on such medications. Profound disruptions in acute cardiovascular research highlighted the need for redundancy or back-up planning for teams engaged in time-sensitive research, to ensure both continuity of protocols and patient safety.

Published
2022
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17. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial

Author

Siha, Hany, Das, Debraj, Fu, Yuling, Zheng, Yinggan, Westerhout, Cynthia M., Storey, Robert F., James, Stefan, Wallentin, Lars, and Armstrong, Paul W.

Subjects
Merck & Company Inc., Bristol-Myers Squibb Co., Eli Lilly and Co., Coronary heart disease -- Prognosis -- Care and treatment -- Health aspects, Medical research -- Health aspects, Medicine, Experimental -- Health aspects, Mortality -- United States, Heart beat -- Health aspects, Electrocardiography -- Health aspects, Clinical trials -- Health aspects, Electrocardiogram -- Health aspects, Cardiac patients -- Prognosis -- Care and treatment -- Health aspects, Pharmaceutical industry -- Health aspects, Transluminal angioplasty -- Health aspects, Health
Abstract

Background: Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial Methods: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality. Results: Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02). Interpretation: The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. Clinical Trials.gov registration no. NCT00391872, The clinical outcome of patients with ST-segment elevation myocardial infarction (STEMI) is directly related to the extent of myocardial necrosis. (1) Because the extent of necrosis is strongly influenced by [...]

Published
2012
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18. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART)

Author

Jernberg, Tomas, Attebring, Mona F., Hambraeus, Kristina, Ivert, Torbjorn, James, Stefan, Jeppsson, Anders, Lagerqvist, Bo, Lindahl, Bertil, Stenestrand, Ulf, and Wallentin, Lars

Subjects
Coronary heart disease -- Care and treatment, Coronary heart disease -- Patient outcomes, Evidence-based medicine -- Practice, Evidence-based medicine -- Standards, Outcome and process assessment (Health Care) -- Comparative analysis, Patients -- Care and treatment, Patients -- Standards, Health
Published
2010

20. Effects of early myocardial reperfusion and perfusion on myocardial necrosis/dysfunction and inflammation in patients with ST-segment and non-ST-segment elevation acute coronary syndrome: results from the PLATelet inhibition and patients Outcomes (PLATO) trial

Author

Batra, Gorav, Renlund, Henrik, Kunadian, Vijay, James, Stefan K, Storey, Robert F, Steg, P Gabriel, Katus, Hugo A, Harrington, Robert A, Gibson, C Michael, Budaj, Andrzej, Siegbahn, Agneta, and Wallentin, Lars

Abstract

Graphical Abstract

Published
2022
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24. Bleeding avoidance strategies in percutaneous coronary intervention

Author

Capodanno, Davide, Bhatt, Deepak L., Gibson, C. Michael, James, Stefan, Kimura, Takeshi, Mehran, Roxana, Rao, Sunil V., Steg, Philippe Gabriel, Urban, Philip, Valgimigli, Marco, Windecker, Stephan, and Angiolillo, Dominick J.

Abstract

For many years, bleeding has been perceived as an unavoidable consequence of strategies aimed at reducing thrombotic complications in patients undergoing percutaneous coronary intervention (PCI). However, the paradigm has now shifted towards bleeding being recognized as a prognostically unfavourable event to the same extent as having a new or recurrent ischaemic or thrombotic complication. As such, in parallel with progress in device and drug development for PCI, there is clinical interest in developing strategies that maximize not only the efficacy but also the safety (for example, by minimizing bleeding) of any antithrombotic treatment or procedural aspect before, during or after PCI. In this Review, we discuss contemporary data and aspects of bleeding avoidance strategies in PCI, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens.

Published
2022
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26. Development and validation of an artificial neural network algorithm to predict mortality and admission to hospital for heart failure after myocardial infarction: a nationwide population-based study

Author

Mohammad, Moman A, Olesen, Kevin K W, Koul, Sasha, Gale, Chris P, Rylance, Rebecca, Jernberg, Tomas, Baron, Tomasz, Spaak, Jonas, James, Stefan, Lindahl, Bertil, Maeng, Michael, and Erlinge, David

Abstract

Patients have an estimated mortality of 15–20% within the first year following myocardial infarction and one in four patients who survive myocardial infarction will develop heart failure, severely reducing quality of life and increasing the risk of long-term mortality. We aimed to establish the accuracy of an artificial neural network (ANN) algorithm in predicting 1-year mortality and admission to hospital for heart failure after myocardial infarction.

Published
2022
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27. Ischemic Benefit and Hemorrhage Risk of Ticagrelor-Aspirin Versus Aspirin in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Author

Johnston, S. Claiborne, Amarenco, Pierre, Aunes, Maria, Denison, Hans, Evans, Scott R., Himmelmann, Anders, Jahreskog, Marianne, James, Stefan, Knutsson, Mikael, Ladenvall, Per, Molina, Carlos A., Nylander, Sven, Röther, Joachim, and Wang, Yongjun

Abstract

Supplemental Digital Content is available in the text.

Published
2021
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28. Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke: An Exploratory Analysis of the THALES Randomized Clinical Trial

Author

Wang, Yongjun, Pan, Yuesong, Li, Hao, Amarenco, Pierre, Denison, Hans, Evans, Scott R., Himmelmann, Anders, James, Stefan, Birve, Filip, Ladenvall, Per, Molina, Carlos A., and Johnston, S. Claiborne

Abstract

IMPORTANCE: Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. OBJECTIVE: To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). DESIGN, SETTING, AND PARTICIPANTS: The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019. This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. INTERVENTIONS: Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30. Patients were observed for 30 additional days. MAIN OUTCOMES AND MEASURES: The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding. RESULTS: In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of 3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26). CONCLUSIONS AND RELEVANCE: In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03354429

Published
2021
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29. Findings on Coronary Angiographies in Patients With Rheumatoid Arthritis and Ischemic Heart Disease: Are They Different From Patients Without Rheumatoid Arthritis?

Author

Holmqvist, Marie, Mantel, Ängla, Wållberg‐Jonsson, Solveig, James, Stefan, Jernberg, Tomas, and Askling, Johan

Abstract

Patients with rheumatoid arthritis (RA) are at increased risk of coronary artery disease (CAD) and seem to develop more severe acute coronary syndromes (ACS) than the general population. Because few studies have investigated the CAD distribution in the context of acute or stable CAD in RA, the objective was to investigate whether this risk is due to a different distribution and severity of coronary stenoses (versus non‐RA), resulting in clinical manifestation of CAD. We performed a population‐based study using linkages of nationwide clinical, health, and demographics registers. We compared 1 cohort of patients with RA, and 1 matched cohort of patients without RA, undergoing a first coronary angiography from 2006 through 2015. Cardiovascular (CV) characteristics and the presence and distribution of clinically significant stenoses were compared (through odds ratios [ORs]), stratified by indication (stable CAD, ST‐elevation myocardial infarction [STEMI], and non–ST‐elevation ACS [NSTACS]), using logistic regression. We identified 2,985 patients with RA and 10,290 patients without RA who underwent a first coronary angiography. A higher proportion of patients with RA (75% versus 69%) had STEMI and NSTACS as indication for angiography. We found no difference in the presence and distribution of clinically significant coronary stenoses in RA compared with the patients without RA, regardless of the CAD type (for having any significant stenosis in stable CAD OR 0.9, STEMI OR 0.8, and NSTACS OR 1.1), stratification by RA duration, sex, or burden of concomitant CV risk factors. Although RA may accelerate the development of clinical CAD events, the underlying angiographic characteristics are similar to those in patients without RA.

Published
2021
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30. Patients’ experiences of clinical trial participation involving a product remotely assessing study drug adherence

Author

Henriksson, Catrin, Olsson, Anneli, Andersen, Kasper, Arefalk, Gabriel, Erlinge, David, Hofmann, Robin, Ridderstråle, Wilhelm, Rutgersson, Annika, Oldgren, Jonas, and James, Stefan

Abstract

The participation of patients in clinical trials is crucial for the development of healthcare. There are several challenges in the recruitment of trial participants with acute medical conditions. The registry-based randomized DAPA-MI clinical trial recruited patients during hospitalization for myocardial infarction and provided study drugs in bottles with smart caps that used wireless technology to transmit monitoring data. This interview study aimed to investigate patients’ experience of participation in a clinical trial and their attitude to the new bottle cap technology.

Published
2024
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32. Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial

Author

Bhatt, Deepak L, Steg, Philippe Gabriel, Mehta, Shamir R, Leiter, Lawrence A, Simon, Tabassome, Fox, Kim, Held, Claes, Andersson, Marielle, Himmelmann, Anders, Ridderstråle, Wilhelm, Chen, Jersey, Song, Yang, Diaz, Rafael, Goto, Shinya, James, Stefan K, Ray, Kausik K, Parkhomenko, Alexander N, Kosiborod, Mikhail N, McGuire, Darren K, Harrington, Robert A, Santos, Vladimir, Jain, Ashit, Lendel, Irina, Russo, Michael, Haught, W H, Bouza, Manuel, Gogia, Harinder, Banerjee, Supratim, Kichura, George, Kantaros, Louis, Padron, Francisco, Passi, Rakesh, Stone, Jay, Pursley, Michael, D'Urso, Michael, Gardner, Timothy, Bennett, James, Nour, Khaled, Saini, Satinder, Zhang, Wenwu, Kumbhani, Dharam, Thomas, Dustin, Angiolillo, Dominick, Bertolet, Barry, Roman-Miranda, Amaury, Black, Robert, Manshadi, Ramin, Vaca, Carlos, Blanco, Antonio, Napoli, Mark, Brabham, David, Akyea-Djamson, Ayim, Desai, Pratik, Prasada, Sudhir, Khaira, Ajit, Forgosh, Leslie, Lieber, Ira, Umpierrez, Guillermo, Singal, Dinesh, Londono, Juan, Fraser, Neil, Ruiz, Jose, Vega, Damaris, Rodriguez, Lilia, Brown, Christopher, Syed, Faizullah, Aggarwala, Guarav, Eaves, William, Foster, Michael, Gupta, Dinesh, Avino, David, Asfour, Wail, Tonnessen, Glen, Zhao, Xue-Qiao, Singh, Narendra, Brockmyre, Andrew, Lepor, Norman, Shammas, Nicolas, Blick, David, Hearne, Steven, Prodafikas, John, Carell, Edgar, Izzo, Mark, Karim, Amin, Zakhary, Bosh, Atieh, Mahmoud, Leichter, Steven, Meadows, Charles, Hotchkiss, David, Abu-Fadel, Mazen, Wiseman, Alan, Bander, Jeffrey, Shah, Mahesh, Banerjee, Subhash, Ganim, Ricky, Sopko, Karen, Khan, Misal, Lloret, Ramon, Weirick, Troy, Mehta, Rajendra, Thadani, Udho, Bhargava, Anuj, Kosiborod, Mikhail, Moya, Jaynier, Staniloae, Cezar, Guerra, Yamirka D, Chhabra, Anil, Kosmicki, Douglas, Shaheen, Wassim, Mohammed, Akber, Bitters, J'Cinda, Pattanayak, Jan, Javier, Julian, Srivastava, Sunny, Phillips, Roland, Al-Amin, Jessie, Lillestol, Michael, Simpson, Patrick, Hazan, Lydie, Amin, Amit, Shah, Gopi, Korpas, Denes, Platt, Bruce, Dickert, Jim, Puente, Orlando, Hiotis, Louis, Doyle, Timothy, Rajan, Raj, Meholick, Alan, Gring, Christian, Hage-Korban, Elie, Feldman, Robert, Colfer, Harry, Butman, Samuel, Foster, Malcolm, Hart, Terence, Huling, Randall, Eshaghian, Shervin, Quintana, Ofsman, Cheung, Deanna, Handel, Franklin, Rodriguez, Mara, Suh, David, Gordon, Paul, Pressman, Gregg, Bauer, Michael, French, William, Barettella, Mark, Chatrathi, Sridhar, Suresh, Damodhar, Goldberg, Ronald, Huth, Mark, Younis, Liwa, Rahman, Aref, Mascolo, Richard, Welch, Michelle, Suneja, Randeep, Smith, Stephen, Shurmur, Scott, Agaiby, John, Jingo, Ahmad, Johnston, Janice, Beth, Mary, Vlastaris, Anthony, Kemp, Susan, Taheri, Hamid, Pereira, Edward, Deyoung, Michael, Hawa, Zafir, Smith, Ray, Galski, Thomas, Garas, Samer, Reddy, M, Sharma, Susheel, Hargrove, Joeseph, Treasure, Charles, Emerson, Ronald, Haddad, Tariq, Rohr, Kathryn, Levinson, Larry, Gaona, Raul, Uretsky, Barry, Maheshwari, Hiralal, Lee, Denny, Kinnaman, Stephanie, Singal, Robert, Geohas, Jeffrey, Gigliotti, Osvaldo, Raisinghani, Ajit, Khurana, Charanjit, Hella, Brent, Kelberman, Michael, Voyce, Steven, Singh, Sanjay, Lo, Eric, Singh, Pradeep, Goodfellow, Ross, Fischer, Stuart, Lorraine, Richard, Turner, Traci, Shanes, Jeffrey, Busch, Robert, Broker, Robert, Zaniewski, Michelle, Pounds, Kevin, Debs-Perez, Giselle, Ong, Stephen, Frandsen, Brad, Fullington, Douglas, Jaffrani, Naseem, Khan, Ahtaram, Lee, Marcus, Pouzar, Joe, Revtyak, George, Gonzalez, Julian, Nakhle, Samer, Murillo, Abel, Young, Douglas, Makam, Sashi, Syed, Mushtaq, Woolf, Kevin, Grena, Paul, Alfata, Sarab, Mahal, Sharan, Hoffman, David, Kizhakekuttu, Tinoy, Deering, Joseph, Bhavsar, Janak, Mikesell, Scott, Wilson, William, Wilson, Vance, El, Salah, Spinale, Francis, Kannarkat, Vinod, Rao, Sunder, Hanson, Lenita, Bertsch, John, Gonzalez-Ortiz, Elena, Severino, Norma, Willis, John, Schock, Joel, Bakhtari, Ladan, Gazmuri, Raul, Ansari, Saadat, Hall, Jason, Mehta, Arvind, Shealy, Neal, Zarich, Stuart, Singh, Deovrat, Vora, Kishor, Andrawis, Nabil, Molter, Darron, Maron, David, Cardona, Jose, D'Agostino, Ronald, Arshad, Tamjeed, Samaan, Rodney, Jones, David, Presser, Dale, Heath, John, Green, Sandy, Bittar, George, Henry, Sheldon, Korn, David, Schmedtje, John, Nadar, Venkatesh, Graham, Bruce, Labroo, Ajay, Clavijo, Leonardo, Roseman, Hal, Ledesma, Gilbert, Rosen, Robert, Dor, Isaac, Kirby, William, Sutton, Jennefer, Eder, Frank, Iteld, Bruce, Gomez-Cortes, Jose, Buchbinder, Maurice, Kasper, Joseph, Terrelonge, Antonio, Torres, Gustavo, Jagielo, Ted, Alvarez, Jose, Handelsman, Yehuda, Guillen, Mario, Richwine, Randall, Lewy-Alterbaum, Lorena, Corder, Clinton, Arvind, Moogali, Bolshoun, David, Mikhail, Magdy, Minton, Stephen, Alvarado, Odilon, Abbott, J, Cauthen, Brett, Welter, Ryan, Mintz, Randy, Cox, John, Quick, Annette, Weiss, Melvin, Dy, Johnny, Zebrack, James, Gandelman, Glenn, Hegde, Vinayak, Silver, Marc, DeGregorio, Michele, Lawson, William, Paa, Christopher, Bortnick, Anna, Krolick, Merrill, Sotolongo, Rodolfo, Cheirif, Jorge, Kumar, Priya, Nadar, Venkatesh, Jetty, Preetham, Patel, Ambar, Kruk, Mariusz, Kobielusz-Gembala, Iwona, Rewerska, Barbara, Madrzejewski, Adam, Milewski, Krzysztof, Cygler, Jerzy, Petryka-Mazurkiewicz, Joanna, Jastrzebski, Waldemar, Korecki, Janusz, Fil, Wojciech, Prokopczuk, Janusz, Bochenek, Anna, Wujkowski, Marek, Witek, Robert, Konczakowski, Piotr, Miekus, Pawel, Szczasny, Marcin, Musial, Wlodzimierz, Cymerman, Krzysztof, Lampart, Jacek, Mikosinski, Jacek, Szynal, Slawomir, Fares, Issa, Opolski, Grzegorz, Mazur, Stanislaw, Wozakowska-Kaplon, Beata, Bijata-Bronisz, Renata, Wierucki, Lukasz, Losa, Beata, Drelich, Grzegorz, Konieczny, Marek, Starczewski, Pawel, Pawlowicz, Lidia, Jesionowski, Pawel, Jurowiecki, Jaroslaw, Gniot, Jacek, Czyzycki, Mariusz, Stania, Karol, Kucharczyk-Bauman, Izabela, Busz-Papiez, Benita, Karczmarczyk, Agnieszka, Sudnik, Wanda, Koszek, Alina, Kolodziej, Piotr, Skwarna, Bartosz, Jaramillo, Nicolás, Jankowski, Maciej, Czochra, Wojciech, Kinasz, Leszek, Miklaszewicz, Beata, Stasinska, Teresa, Pluta, Wladyslaw, Basiak, Marcin, Rusicka, Teresa, Niedbal-Yahfouf, Izabela, Popenda, Grazyna, Korzeniak, Romuald, Mirek, Agnieszka, Mariankowski, Rafal, Wojnowski, Lukasz, Korol, Marek, Baszak, Jacek, Podolec, Piotr, Piesiewicz, Wojciech, Zurakowski, Aleksander, Luengas, Carlos, Skura, Marek, Pilecki, Piotr, Majchrzak, Piotr, Krzyzagórska, Ewa, Drozd, Marcin, Kaczmarek, Barbara, Sliwinska, Teresa, Zelazowska, Katarzyna, Sztembis, Rafal, Landa, Katarzyna, Matyszczak-Toniak, Lidia, Strojek, Krzysztof, Piepiorka, Marek, Malinowski, Robert, Górska, Maria, Stolarczyk-Sowa, Edyta, Romanowski, Leszek, Zinka, Elzbieta, Reszka, Zygfryd, Skierkowska, Joanna, Uzunow, Anna, Laskowska-Derlaga, Ewa, Puntus, Ekaterina, Kosmacheva, Elena D, Koziolova, Natalia, Pavlov, Prokhor, Supryadkina, Tatiana, Didenko, Yury, Kopylov, Philipp, Kazakov, Andrei, Aksentiev, Sergei, Vishneva, Elena, Repin, Alexey, Smolenskaya, Olga, Mantserova, Olga, Khrustalev, Oleg, Privalova, Elena, Konstantinov, Vladimir, Boldueva, Svetlana, Ezhov, Andrey, Chernyavsky, Alexander, Kamalov, Gadel, Galyavich, Albert, Zubeeva, Galina, Nechaeva, Galina, Shustov, Sergey, Dzhaiani, Nino, Treshkur, Tatiana, Osokina, Nataliya, Panov, Alexey, Shutemova, Elena, Makukhin, Valeriy, Kropotina, Tatiana, Tsyba, Larisa, Karpov, Yuri, Sizova, J M, Ballyuzek, Marina, Tarasov, Nikolay, Demchenko, Elena, Barbarash, Olga, Moiseev, Valentin, Markov, Valentin, Kuznetsov, Vadim, Viktorova, Inna, Sergienko, Igor, Ermoshkina, Lyudmila, Khasanov, Niyaz, Khlevchuk, Tatiana, Baglikov, Andrey, Shalaev, Sergey, Zonova, Elena, Reznik, Elena, Haisheva, Larisa, Morugova, Tatyana, Lomakin, Nikita, Vishnevsky, Alexander, Shvarts, Yuri, Magnitskaya, Olga, Mikhailusova, Marina, Pavlysh, Elena, Libov, Igor, Zateyschikova, Anna, Kostenko, Victor, Edin, Anton, Khovaeva, Yaroslava, Zakharov, Konstantin, Stryuk, Raisa, Khirmanov, Vladimir, Kanorskiy, Sergey, Yakushin, Sergey, Barabashkina, Anna, Li, Hongwei, Zhao, Qiang, Zhang, Jian, Ma, Jianhua, He, Yong, Luo, Ming, Zhang, Aidong, Zhang, Ningru, Chai, Yingru, Ma, Genshan, Wang, Hao, Liu, Zhigang, He, Lanjie, Song, Zhifang, Dong, Xiaolin, Tao, Liang, Li, Zhanquan, Su, Xi, Kong, Xiangqing, Niu, Heping, Ge, Junbo, Luo, Zhurong, Huang, Wenjun, Peng, Daoquan, Yuan, Zuyi, Milanova, Maria, Tenev, Doncho, Gogov, Antoni, Karageorgiev, Dimitar, Kolchev, Todor, Rusev, Nikolay, Georgieva, Nikolina, Kondov, Rumen, Rusinov, Veselin, Petrov, Ivo, Stanchev, Georgi, Konteva, Mariana, Dincheva, Adriana, Yaneva, Zdravka, Vatova, Ralitsa, Ilieva, Katya, Runev, Nikolai, Kolomanov, Borislav, Petrov, Ivan, Iliev, Nikolay, Tisheva, Snezhanka, Chompalova, Boryana, Tokmakova, Maria, Raev, Dimitar, Byanov, Kolyo, Markov, Dimitar, Mihov, Lenko, Mihov, Atanas, Milcheva, Nora, Minchev, Milen, Mollov, Mihail, Borisov, Borislav, Tihchev, Tihomir, Karakolev, Venelin, Dimov, Bojidar, Georgiev, Svetoslav, Smilov, Lachezar, Koo, Bon K, Ahn, Taehoon, Hong, Soon J, Yoon, Junghan, Oh, Seok K, Jeong, Myung H, Kim, Doo-Il, Chang, Kiyuk, Kim, Weon, Hahn, Joo-Yong, Cha, Kwang S, Lee, Jung-Hee, Choi, Si-Wan, Nam, Chang-Wook, Chae, In-Ho, Park, Yong H, Tahk, Seung-Jea, Shin, Won-Yong, Chae, Jei-Keon, Kim, Byung J, Bae, Jang-Whan, Park, Woo J, Rha, Seung W, Choi, Young J, Hwang, Jin-Yong, Park, Hun S, Baracioli, Luciano, Guimaraes, Fabio, Vasconcellos, Eduardo, Saraiva, José, Pereira, Adamastor, Santos, Queulla, Rossi, Paulo, Maia, Lilia, Madeira, Miguel, Pereira, Marcio, Botelho, Roberto, Reis, Gilmar, Eliaschewitz, Freddy, Borges, Joao, Nascimento, Carlos, Fortes, Jose A, de Souza, Weimar, Pimentel, Pedro, Hissa, Miguel, Franchetti, Marcos, Precoma, Dalton, Ortiz, Costantino, Hernandes, Mauro, Saporito, Wladmir, dos Santos, Fabio R, Kormann, Adrian, Neuenschwander, Fernando, Dutra, Oscar, Rassi, Nelson, Tanajura, Luiz, Souza, Juliana, Junior, Delcio S, Leaes, Paulo, Forte, Adriana, Bonansea, Teresa C, Marin, Jose, Machado, Bruno, Cerqueira, Maria J, Silva, Frederico, Michalaros, Yorghos, Manenti, Euler, Cercato, Cintia, Figueiredo, Estevao, Liu, Ming-En, Wang, Yi-Chih, Lee, Tsung-Ming, Fang, Chih, Wu, Yen-Wen, Ueng, Kwo-Chang, Sheu, Huey-Herng, Lai, Wen T, Hsieh, I-Chang, Chen, Zhih-Cherng, Lee, Mu-Jang, Chiang, Chern, Shyu, Kou-Gi, Hsia, Chien-Hsun, Mar, Guang-Yuan, Chan, Shih-Hung, Wu, Chih-Cheng, Tseng, Wei-Kung, Chang, Kuan-Cheng, Yeh, Hung-I, Wang, Ji-Hung, Hou, Charles, Sorokina, Inna, Dolzhenko, Maryna, Horoshko, Olha, Karpenko, Oleksandr, Rudenko, Leonid, Vakaliuk, Igor, Kulyk, Anna, Levchenko, Olena, Prokhorov, Oleksandr, Reshotko, Dmytro, Sorokivskyy, Mykhaylo, Velichko, Nataliia, Maslovskyi, Valentyn, Teliatnikova, Zinaida, Dotsenko, Sergiy, Krakhmalova, Olena, Kraiz, Igor, Zharinova, Viktoria, Bula, Larysa, Kaydashev, Igor, Molodtsov, Valeriy, Rasputina, Lesya, Pidlisna, Viktoriya, Lysunets, Olena, Kravchenko, Anatoliy, Glushko, Liubomyr, Khomazyuk, Tetyana, Svyshchenko, Yevgeniya, Parkhomenko, Oleksandr, Mankovsky, Boris, Abrahamovych, Orest, Yagensky, Andriy, Stanislavchuk, Mykola, Vasilyeva, Larisa, Sokolova, Liubov, Sychov, Oleg, Tseluyko, Vira, Kyrychenko, Igor, Rishko, Mykola, Furkalo, Sergiy, Gallo, Richard, Bertrand, Olivier, Mehta, Shamir, Constance, Christian, Sussex, Bruce, Zadra, Remo, Kouz, Simon, Chehayeb, Raja, Pandey, Amritanshu, Dion, Danielle, Bailey, Gordon, Hill, Laurie, Ramanathan, Krishnan, Dorsch, Micha, Nanji, Alykhan, Babapulle, Mohan, Montigny, Martine, Gosselin, Gilbert, Dehghani, Payam, Rupka, Dennis, Le May, Michel, Pichette, Francis, St-Maurice, Francois, Teefy, Patrick, Mansour, Samer, Kassam, Saleem, Cheung, Stephen, Siega, Anthony D, O'Keefe, Dennis, Sabbah, Eric, Bell, Alan, Chouinard, Guy, Wong, Brian, Miller, Mark, Gaudet, Daniel, Lachance, Pierre, Bata, Iqbal, Petrella, Robert, Gossard, Denis, Dumas, Richard, Ing, Douglas, Boyrazian, Hagop, Bessoudo, Ricardo, Huynh, Thao T, Hart, Randy, Belle-Isle, Jasmin, Shukla, Dinkar, Kelly, Allan, Mazza, Giuseppe, Cha, James, Henein, Sam, Frechette, Andre, Vizel, Saul, Liutkus, Joanne F, O'Mahony, Michael, Halperin, Frank, Kooy, Jacobus, Graham, John, Bailey, Allan, Wojcik, Ronald, Wilderman, Igor, Turi, Tibor, Motyovszki, Ákos, Merkely, Béla, Király, Csaba, Andrássy, Péter, Sárszegi, Zsolt, Fülöp, Tibor, Zilahi, Zsolt, Édes, István, Papp, Andras, Müller, Gábor, Czigány, Anna, Zólyomi, Szilárd, Korányi, László, Takács, János, Juhász, Ferenc, Benczur, Bela, Kancz, Sándor, Földi, András, Nagy, András C, Bakai, Judit, Greschik, István, Püski, László, Nagy, László, Kirschner, Róbert, Kuchar, Roman, Hajek, Petr, Busak, Ladislav, Michalik, Daniel, Matyasek, Ivo, Marusincova, Ivana, Kucera, Dusan, Jerabek, Ondrej, Honkova, Michaela, Dedek, Vratislav, Rihacek, Ivan, Kos, Pavel, Slaby, Josef, Machkova, Martina, Zidkova, Eva, Elbl, Lubomir, Grunfeldova, Hana, Carda, Jiri, Mrozek, Vladimir, Maly, Jiri, Milkovic, Richard, Malecha, Jan, Skalicka, Hana, Oral, Ivo, Krcova, Eva, Lisa, Libor, Belohlavek, Jan, Miklik, Roman, Cermak, Ondrej, Bednarova, Jana, Peroutka, Zdenek, Spinar, Jindrich, Wilke, Andreas, Appel, Karl-Friedrich, Taggeselle, Jens, Förster, Andreas, Toursarkissian, Nicole, Schmidt, Ekkehard, Bott, Jochen, Al-Zoebi, Ayham, Hennig, Dirk, Fischer, Sabine, Schön, Norbert, Sauter, Joachim, Simonis, Gregor, Nischik, Ruth, Rieker, Werner, Schenkenberger, Isabelle, Behnke, Thomas, Klausmann, Gerhard, Jeserich, Michael, Trenk, Dietmar, Weigmann, Ingo, Reuter, Hannes, Rummel, Reinhard, von Münchhausen, Candy, von Engelhardt, Charlotte, Horibe, Eishun, Shibasaki, Taro, Sato, Tomohiko, Kakuta, Tsunekazu, Michishita, Ichiro, Tan, Michinao, Ishiki, Ryoji, Aoyama, Takahiko, Higashiue, Shinichi, Niijima, Yawara, Idogaki, Akira, Hasegawa, Toru, Kiyosue, Arihiro, Tomobuchi, Yoshiaki, Kawamitsu, Katsunori, Kawasaki, Satsuki, Hata, Yoshiki, Fukui, Kazuki, Seki, Kozaburo, Takenaka, Takashi, Abe, Mitsuru, Utsu, Noriaki, Oono, Atsuyuki, Mitsuo, Kazuhisa, Sueyoshi, Atsushi, Hirohata, Atsushi, Tsujimoto, Mitsuru, Ueda, Osamu, Takase, Shinichi, Suzuki, Masahiro, Sakuragi, Satoru, Yamamoto, Fumi, Fujimoto, Noritaka, Kakinoki, Shigeo, Sugiura, Tatsushi, Sugino, Hiroshi, Nakamura, Toshihiro, Goto, Shinya, Kadokami, Toshiaki, Uehara, Hiroki, Ono, Masahiro, Yokoya, Koichi, Koike, Akihiro, Komatsu, Sei, Sonoda, Masahiro, Ueno, Hideki, Doi, Tomofumi, Takagi, Yuichiro, Fujimoto, Kazuteru, Eki, Yutaka, Okubo, Munenori, Sasaki, Kenichiro, van Eck, Martijn, Ronner, Eelko, The, Salem, van de Wal, Ruud, Nierop, Pieter, de Nooijer, Cornelis, The, Salem, The, Salem, Werner, Henri, Westendorp, Iris, van der Zwaan, Coen, Crijns, Hendrikus, Cornel, Jan H, Strikwerda, Sipke, Bos, Robert, de Melker, Edwin, Kuijper, Adrianus, Louwerenburg, Hans, Plomp, Jacobus, Dantzig, Jan-Melle, Prins, Francisco, van Kesteren, Henricus, Willems, Frank, Amoroso, Giovanni, Carnero, Gabriela, Duronto, Ernesto, Besada, Diego, Chacon, Carolina, Zangroniz, Pedro, Solis, Silvana, Liberman, Alberto, Sernia, Virginia, Alvarisqueta, Andres, Maffei, Laura, Vilamajo, Oscar G, García, Celso, Sicer, Maximiliano, Muntaner, Juan, Bordonava, Anselmo, Albisu, Juan, Zanini, Alejandra, Rista, Lucas, Hominal, Miguel, Estrada, José N, Prado, Aldo, Gosparini, Diego M, Schiavi, Beatriz, Castillo, Armando G, Ruíz, José G, Martinez, Guillermo R, López, Víctor G, Rosas, Enrique L, Lopez, Gabriel R, Cantu, Elias G, de los Ríos Ibarra, Manuel, Padilla, Francisco P, Carrasco, Jose P, Carrillo, Luis V, García, Joel D, Askar, Alfredo N, Salinas, Carlos A, Gamba, Marco A, Sanchez, Carlos G, Cantú, Arnulfo G, Sánchez, Raul V, Madrigal, Jaime C, Urbano, Rafael H, Romo, Andrés Í, González Juanatey, José R, Racugno, Paolo, Fillat, Angel C, de la Torre Hernández, José M, Peláez, Juan A, Cortada, Jorge B, Pavia, Pablo G, Navarro, Manuel J, Asenjo, Roberto M, Díaz, Francisco F, Peligero, Eduard B, Manterola, Fernando A, Ortiz, Antonio F, Mediavilla García, Juan D, Ortuño, Francisco M, Vera, Tomás R, González, Alfonso S, Viñas, Jaime A, Fernández Portales, Francisco J, Mayordomo, Petra S, Ojeda, Francisco B, Domínguez, Antonio R, González, Rosa S, Guerrero, Diego B, Ruiz Nodar, Juan M, Marimon, Xavier G, Margáez, José G, Aguilera, Roberto M, Díaz Fernández, José F, Zamorano Gómez, José L, González, Vicente B, del Blanco, Bruno G, Pérez, Ignacio P, Moreno, Mercé R, Ereño, Ainhoa R, García Lledó, José A, Prieto, Juan, Villablanca, Alex, Raffo, Carlos, Pincetti, Christian, Conejeros, Carlos, Roman, Oscar, Rodriguez, Manuel, Varleta, Paola, Goldberg, Cindy, Sandoval, Jorge, Arriagada, German, Leon, Lucio, Potthoff, Sergio, Cobos, Jorge, Figueroa, Christian, Makotoko, Ellen, Fourie, Nyda, Burgess, Lesley, Nortje, Hendrik, Theron, Rust, Pillai, Perumal, Ranjith, Naresh, Trokis, Julien, Pillay, Soobramoney, Reddy, Jeevren, Nunkoo, Theema, Kapp, Cornelia, Urbach, Dorothea, Distiller, Lawrence, Horak, Adrian, van Zyl, Louis, Coetzee, Kathleen, Punt, Zelda, Bayat, Junaid, Dawood, Saleem, Mitha, Ismail, Padayachee, Trevenesan, Hoosen, Farzana, Dalby, Anthony, Prabhavathi, Gowdaiah, Prakash, Mehta, Vimal, Chag, Milan, Gadkari, Milind, Ramamurthee, Kannaiyan, Das, Asit, Sawhney, Jitendra S, Banerjee, Suvro, Sathe, Prachee, Adhyapak, Srilakshmi, Nguyen, Tuan, Pham, Vinh, Do, Huan, Nguyen, Anh, Nguyen, Hien, Truong, Binh, Jamil-Copley, Shahnaz, Lang, Chim, Pell, Alastair, Zaman, Azfar, Storey, Robert, Swanson, Neil, Smith, Simon, Sharman, David, Braganza, Denise, Hammond, Peter, Moriarty, Andrew, Bain, Stephen, Pye, Maurice, Sharp, Andrew, Blagden, Mark, Randeva, Harpal, Myhill, Timothy, Viswanathan, Girish, Keeling, Philip, Clifford, Piers, Saxena, Manish, Lyons, Kristopher, McMurray, John, Jaafar, Feeroz, Murphy, Clare, Cartwright, Simon, Abouglila, Kamal, Antalik, Lubomir, Krajci, Peter, Urban, Miroslav, Fazekas, Frantisek, Pella, Daniel, Koleny, Daniel, Vykoukalova, Tatiana, Macek, Vladimir, Vinanska, Daniela, Jamriskova, Livia, Such, Slavomir, Fulop, Peter, Farsky, Stefan, Bugan, Viliam, Strbova, Jaroslava, Micko, Karol, Palka Jr, Juraj, Sivak, Vladimir, Kristensen, Dalby, Refsgaard, Jens, Holmvang, Lene, Dixen, Ulrik, Nielsen, Henrik, Egstrup, Kenneth, Jensen, Lisette O, Sykulski, Roman, Rasmussen, Ole, Andries, Alin, Luckow, Anders, Nielsen, Gitte, Sørensen, Torben, Wongvipaporn, Chaiyasith, Chamnarnphol, Noppadol, Srimahachota, Suphot, Sansanayudh, Nakarin, Kuanprasert, Srun, Tresukosol, Damras, Sookananchai, Bancha, Kanadasi, Mehmet, Ozcan, Turkay, Kucuk, Murathan, Ongen, Zeki, Okuyan, Ertugrul, Arat, Alev, Acikel, Sadik, Yalcin, Ahmet, Guray, Umit, Ceyhan, Ceyhun, Ozer, Necla, Arslan, Sakir, Angerås, Oskar, Johnston, Nina, Weiderman, Ann-Charlotte, Bandh, Stellan, Hansen, Ole, Larnefeldt, Hans, Kusiak, Dawid, Lindholm, Carl-Johan, Hedman, Anders, Erlinge, David, Curiac, Dan, Lundman, Pia, Zucconi-Mazzini, Roberto, Aladellie, Layth, Jensen, Jens, Verwerft, Jan, Vrolix, Mathias, Faes, Dirk, Striekwold, Harry, Sinnaeve, Peter, Timmermans, Patrick, Guedes, Antoine, Delforge, Marc, Nimmegeers, Jan, Stammen, Francis, Buysschaert, Ian, Hoffer, Etienne, Hollanders, Geert, Vervoort, Geert, Coussement, Patrick, de Maeseneire, Stefan, Janssens, Luc, Gravdal, Stein A, Risberg, Knut, Gullestad, Lars, Hofseth, Ola D, Nilsen, Dennis, Lappegård, Knut T, van den Heuvel, Christian, Gibbs, Charlotte, Khusrawi, Alamdar, Arora, Satish, Tomala, Tadeusz, Kjærnli, Thorbjørn, Berg-Johansen, Jan, Hagemeier, Robert, Skjelvan, Gunnar, Colquhoun, David, Amerena, John, Morbey, Claire, Hammett, Christopher, Dart, Anthony, Lehman, Ronald, Hamilton, Andrew, Worthley, Matthew, Purnell, Peter, Whelan, Alan, MacIsaac, Richard, Arya, Ktut, Linjawi, Sultan, Proietto, Joseph, Prasad, Lakshman, Rodriguez, Aldo, Godoy, Armando, Rodriguez, Victor, Berrospi, Percy, Chavez, Carlos, Negron, Sandra, Heredia, Javier, Medina, Felix, Manrique, Helard, Cabrera, Walter, Cordova, Fernando, Quinteros, Trinidad, Haro, Jaime M, Regalado, Susana, Guitton, Javier, Arbanil, Hugo, Pansieri, Michel, Decoulx, Eric, Goube, Pascal, de Labriolle, Axel, Labeque, Jean N, Range, Gregoire, Cottin, Yves, Montalescot, Gilles, Cayla, Guillaume, Danchin, Nicolas, Angoulvant, Denis, Ferrario, Emile, Elbaz, Meyer, Dubreuil, Olivier, Steg, Philippe G, Fontaine, Caroline, Sorbets, Emmanuel, Omer, Hafiz, Al-Saif, Shukri, Al-Faleh, Hussam, Al-Shehri, Abdullah, Alshehri, Halia, Bazari, Rasha, Hei, Pak, Ying, Man, Chan, Michael, Wong, Michelle, Ma, Ronald, Siu, Shing C, Tsang, Chiu C, Ferrario, Maurizio, Assanelli, Emilio, Senni, Michele, Piatti, Piermarco, Calabrò, Paolo, Urbinati, Stefano, Michisanti, Massimo, Varbella, Ferdinando, de Cosmo, Salvatore, Trevisan, Roberto, Bellotti, Sandro, Di Pasquale, Giuseppe, Bongo, Angelo S, Uguccioni, Massimo, Mannucci, Edoardo, Mauro, Ciro, Ragonese, Mauro, Fresco, Claudio, Turturo, Maurizio, Marcucci, Rossella, Lievano Triana, Manuel J, Arana, Camilo, Accini, Jose, Botero, Rodrigo, Muzyk-Osikowicz, Marlena, Dada, Fredy T, Vallejo, Gregorio S, Manzur, Fernando, Isaza, Daniel, Molina, Dora, Mesa, Juan G, Quintero, Alvaro, Nyman, Kai, Mäkelä, Jyrki, Strand, Jorma, Nieminen, Sakari, Taurio, Jyrki, Kuusela, Matti, Valle, Timo, Pietilä, Mikko, Kekki, Sakari, Strandberg, Timo, Klutstein, Marc, Greenberg, Gabriel, Rozenman, Yoseph, Chorin, Ehud, Roguin, Ariel, Lewis, Basil, Bashkin, Amir, Tan, Edgar, Prado, Jose P, Ferrolino, Arthur, Babilonia, Noe, Barbas, Benny, Matiga, Generoso, Coching, Raul M, Drexel, Heinz, Brath, Helmut, Schnack, Christoph, Hanusch, Ursula, Fließer-Görzer, Evelyn, Paulweber, Bernhard, Ebenbichler, Christoph, Prager, Rudolf, Huber, Kurt, Wolzt, Michael, Auer, Johann, Berger, Rudolf, Schernthaner, Gerit-Holger, Stanciulescu, Gabriela, Creteanu, Mihai, Spiridon, Marilena, Dobreanu, Viorica, Vinereanu, Dragos, Iosipescu, Laura C, Istratoaie, Octavian, Coman, Ioan, Militaru, Constantin, Cinteza, Mircea, Bhatt, Deepak L, Fox, Kim, Harrington, Robert A, Leiter, Lawrence A, Mehta, Shamir R, Simon, Tabassome, Andersson, Marielle, Himmelmann, Anders, Steg, Philippe G, Diaz, Rafael, Amerena, John, Huber, Kurt, Sinnaeve, Peter R, Nicolau, José C, Kerr Saraiva, José F, Petrov, Ivo, Leiter, Lawrence A, Mehta, Shamir R, Corbalán, Ramón, Ge, Junbo, Zhao, Qiang, Botero, Rodrigo, Widimský, Petr, Kristensen, Steen D, Hartikainen, Juha, Danchin, Nicolas, Darius, Harald, Tse, Hung F, Kiss, Robert G, Pais, Prem, Lev, Eli, de Luca, Leonardo, Goto, Shinya, Ramos López, Gabriel A, Cornel, Jan H, Kontny, Frederic, Medina, Felix, Babilonia, Noe A, Opolski, Grzegorz, Vinereanu, Dragos, Zateyshchikov, Dmitry A, Ruda, Mikhail, Elamin, Omer, Kovář, František, Dalby, Anthony J, Jeong, Myung H, Bueno, Héctor, James, Stefan K, Chiang, Chern-En, Tresukosol, Damras, Ongen, Zeki, Ray, Kausik K, Parkhomenko, Alexander, McGuire, Darren K, Kosiborod, Mikhail N, Nguyen, Tuan Q, Andersson, Marielle, Chen, Jersey, Himmelmann, Anders, Leonsson-Zachrisson, Maria, and Ridderstråle, Wilhelm

Abstract

Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor.

Published
2019
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33. Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study

Author

Erlinge, David, Maehara, Akiko, Ben-Yehuda, Ori, Bøtker, Hans Erik, Maeng, Michael, Kjøller-Hansen, Lars, Engstrøm, Thomas, Matsumura, Mitsuaki, Crowley, Aaron, Dressler, Ovidiu, Mintz, Gary S, Fröbert, Ole, Persson, Jonas, Wiseth, Rune, Larsen, Alf Inge, Okkels Jensen, Lisette, Nordrehaug, Jan Erik, Bleie, Øyvind, Omerovic, Elmir, Held, Claes, James, Stefan K, Ali, Ziad A, Muller, James E, Stone, Gregg W, Ahlehoff, Ole, Amin, Azad, Angerås, Oskar, Appikonda, Praveen, Balachandran, Saranya, Barvik, Ståle, Bendix, Kristoffer, Bertilsson, Maria, Boden, Ulrika, Bogale, Nigussie, Bonarjee, Vernon, Calais, Fredrik, Carlsson, Jörg, Carstensen, Steen, Christersson, Christina, Christiansen, Evald Høj, Corral, Maria, De Backer, Ole, Dhaha, Usama, Dworeck, Christian, Eggers, Kai, Elfström, Charlotta, Ellert, Julia, Eriksen, Erlend, Fallesen, Christian, Forsman, Margareta, Fransson, Helena, Gaballa, Mohsen, Gacki, Marek, Götberg, Matthias, Hagström, Lars, Hallberg, Theresa, Hambraeus, Kristina, Haraldsson, Inger, Harnek, Jan, Havndrup, Ole, Hegbom, Knut, Heigert, Matthias, Helqvist, Steffen, Herstad, Jon, Hijazi, Ziad, Holmvang, Lene, Ioanes, Dan, Iqbal, Amjid, Iversen, Allan, Jacobson, Jaclyn, Jakobsen, Lars, Jankovic, Ivana, Jensen, Ulf, Jensevik, Karin, Johnston, Nina, Jonasson, Torfi Fjalar, Jørgensen, Erik, Joshi, Francis, Kajermo, Ulf, Kåver, Frida, Kelbæk, Henning, Kellerth, Thomas, Kish, Mitra, Koenig, Wolfgang, Koul, Sasha, Lagerqvist, Bo, Larsson, Bertil, Lassen, Jens Flensted, Leiren, Olav, Li, Zhe, Lidell, Christer, Linder, Rikard, Lindstaedt, Michael, Lindström, Gunilla, Liu, Shen, Løland, Kjetil Halvorsen, Lønborg, Jacob, Márton, László, Mir-Akbari, Habib, Mohamed, Shameema, Odenstedt, Jacob, Ogne, Christer, Oldgren, Jonas, Olivecrona, Göran, Östlund-Papadogeorgos, Nikolas, Ottesen, Michael, Packer, Erik, Palmquist, Åsa Michelgård, Paracha, Quratulain, Pedersen, Frans, Petursson, Petur, Råmunddal, Truls, Rotevatn, Svein, Sanchez, Raquel, Sarno, Giovanna, Saunamäki, Kari I, Scherstén, Fredrik, Serruys, Patrick W, Sjögren, Iwar, Sørensen, Rikke, Srdanovic, Iva, Subhani, Zuka, Svensson, Eva, Thuesen, Anne, Tijssen, Jan, Tilsted, Hans-Henrik, Tödt, Tim, Trovik, Thor, Våga, Bjørn Inge, Varenhorst, Christoph, Veien, Karsten, Vestman, Emma, Völz, Sebastian, Wallentin, Lars, Wykrzykowska, Joanna, Zagozdzon, Leszek, Zamfir, Manuela, Zedigh, Crister, Zhong, Hang, and Zhou, Zhipeng

Abstract

Near-infrared spectroscopy (NIRS) and intravascular ultrasound are promising imaging modalities to identify non-obstructive plaques likely to cause coronary-related events. We aimed to assess whether combined NIRS and intravascular ultrasound can identify high-risk plaques and patients that are at risk for future major adverse cardiac events (MACEs).

Published
2021
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35. Ticagrelor Added to Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack in Prevention of Disabling Stroke: A Randomized Clinical Trial

Author

Amarenco, Pierre, Denison, Hans, Evans, Scott R., Himmelmann, Anders, James, Stefan, Knutsson, Mikael, Ladenvall, Per, Molina, Carlos A., Wang, Yongjun, and Johnston, S. Claiborne

Abstract

IMPORTANCE: Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke. OBJECTIVE: To evaluate the superiority of ticagrelor added to aspirin in preventing disabling stroke and to understand the factors associated with recurrent disabling stroke. DESIGN, SETTING, AND PARTICIPANTS: The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days. INTERVENTIONS: Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30. MAIN OUTCOMES AND MEASURES: Time to the occurrence of disabling stroke (progression of index event or new stroke) or death within 30 days, as measured by mRS at day 30. Disabling stroke was defined by mRS greater than 1. RESULTS: Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 016 patients, a primary end point with mRS greater than 1 at 30 days occurred in 221 of 5511 patients (4.0%) randomized to ticagrelor and in 260 of 5478 patients (4.7%) randomized to placebo (hazard ratio [HR], 0.83; 95% CI, 0.69-0.99, P = .04). A primary end point with mRS 0 or 1 at 30 days occurred in 70 of 5511 patients (1.3%) and 87 of 5478 patients (1.6%) (HR, 0.79; 95% CI, 0.57-1.08; P = .14). The ordinal analysis of mRS in patients with recurrent stroke showed a shift of the disability burden following a recurrent ischemic stroke in favor of ticagrelor (odds ratio, 0.77; 95% CI, 0.65-0.91; P = .002). Factors associated with disability were baseline National Institutes of Health Stroke Scale score 4 to 5, ipsilateral stenosis of at least 30%, Asian race/ethnicity, older age, and higher systolic blood pressure, while treatment with ticagrelor was associated with less disability. CONCLUSIONS AND RELEVANCE: In patients with TIA and minor ischemic stroke, ticagrelor added to aspirin was superior to aspirin alone in preventing disabling stroke or death at 30 days and reduced the total burden of disability owing to ischemic stroke recurrence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03354429

Published
2021
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36. Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial

Author

Andell, Pontus, James, Stefan, Östlund, Ollie, Yndigegn, Troels, Sparv, David, Pernow, John, Jernberg, Tomas, Lindahl, Bertil, Herlitz, Johan, Erlinge, David, and Hofmann, Robin

Abstract

Background: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.Methods and results: A total of 6629 patients with suspected acute myocardial infarction were randomly assigned in the DETO2X-AMI trial to oxygen or ambient air. In the oxygen group (n=3311) and the ambient air group (n=3318), 155 and 141 patients, respectively, had chronic obstructive pulmonary disease (prevalence of 4.5%). Patients with chronic obstructive pulmonary disease were older, had more comorbid conditions and experienced a twofold higher risk of death at one year (chronic obstructive pulmonary disease: 32/296 (10.8%) vs. non-chronic obstructive pulmonary disease: 302/6333 (4.8%)). Oxygen therapy compared to ambient air was not associated with improved outcomes at 365 days (chronic obstructive pulmonary disease: all-cause mortality hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.50–1.99, Pinteraction=0.96); cardiovascular death HR 0.80, 95% CI 0.32–2.04, Pinteraction=0.59); rehospitalisation with acute myocardial infarction or death HR 1.27, 95% CI 0.71–2.28, Pinteraction=0.46); hospitalisation for heart failure or death HR 1.08, 95% CI 0.61–1.91, Pinteraction=0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.Conclusions: Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial’s findings.Clinical Trials Registration: NCT02290080

Published
2020
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38. Delayed Clinical Manifestation of Parkinson’s Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?1

Author

Olsson, Tomas T., Svensson, Martina, Hållmarker, Ulf, James, Stefan, and Deierborg, Tomas

Abstract

Physical activity is associated with reduced risk of Parkinson’s disease (PD). The explanations for this association are not completely elucidated. We use long-term PD-incidence data from long-distance skiers to study the relationship between exercise and PD. We aimed to investigate if physical activity is associated with long-term lower risk of PD and if this association could be explained by physically active people being able to sustain more PD neuropathology before clinical symptoms, a motor reserve. Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685), exhibited reduced incidence of PD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5–15 years). Vasaloppet skiers (median age 36.0 years [IQR 29.0–46.0], 38% women) had lower incidence of PD (HR: 0.71; 95 % CI 0.56–0.90) compared to non-skiers. When reducing risk for reverse causation by excluding PD cases within the first five years from race participation, there was still a trend for lower risk of PD (HR: 0.80; 95 % CI 0.62–1.03). Further, the PD prevalence converged between skiers and non-skiers after 15 years of follow-up, which is more consistent with a motor reserve in the physically active rather than neuroprotection. A physical active lifestyle is associated with reduced risk for PD. This association weakens with time and might be explained by a motor reserve among the physically active.

Published
2020
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39. Association of Factor V Leiden With Subsequent Atherothrombotic Events

Author

Mahmoodi, Bakhtawar K., Tragante, Vinicius, Kleber, Marcus E., Holmes, Michael V., Schmidt, Amand F., McCubrey, Raymond O., Howe, Laurence J., Direk, Kenan, Allayee, Hooman, Baranova, Ekaterina V., Braund, Peter S., Delgado, Graciela E., Eriksson, Niclas, Gijsberts, Crystel M., Gong, Yan, Hartiala, Jaana, Heydarpour, Mahyar, Pasterkamp, Gerard, Kotti, Salma, Kuukasjärvi, Pekka, Lenzini, Petra A., Levin, Daniel, Lyytikäinen, Leo-Pekka, Muehlschlegel, Jochen D., Nelson, Christopher P., Nikus, Kjell, Pilbrow, Anna P., Wilson Tang, W.H., van der Laan, Sander W., van Setten, Jessica, Vilmundarson, Ragnar O., Deanfield, John, Deloukas, Panos, Dudbridge, Frank, James, Stefan, Mordi, Ify R, Teren, Andrej, Bergmeijer, Thomas O., Body, Simon C., Bots, Michiel, Burkhardt, Ralph, Cooper-DeHoff, Rhonda M., Cresci, Sharon, Danchin, Nicolas, Doughty, Robert N., Grobbee, Diederick E., Hagström, Emil, Hazen, Stanley L., Held, Claes, Hoefer, Imo E., Hovingh, G. Kees, Johnson, Julie A., Kaczor, Marcin P., Kähönen, Mika, Klungel, Olaf H., Laurikka, Jari O., Lehtimäki, Terho, Maitland-van der Zee, Anke H., McPherson, Ruth, Palmer, Colin N., Kraaijeveld, Adriaan O., Pepine, Carl J., Sanak, Marek, Sattar, Naveed, Scholz, Markus, Simon, Tabassome, Spertus, John A., Stewart, Alexandre F.R., Szczeklik, Wojciech, Thiery, Joachim, Visseren, Frank L.J., Waltenberger, Johannes, Richards, A. Mark, Lang, Chim C., Cameron, Vicky A., Åkerblom, Axel, Pare, Guillaume, März, Winfried, Samani, Nilesh J., Hingorani, Aroon D., ten Berg, Jurriën M., Wallentin, Lars, Asselbergs, Folkert W., and Patel, Riyaz S.

Abstract

Supplemental Digital Content is available in the text.

Published
2020
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40. Complete vs Culprit-Lesion-Only Revascularization for ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-analysis

Author

Bainey, Kevin R., Engstrøm, Thomas, Smits, Pieter C., Gershlick, Anthony H., James, Stefan K., Storey, Robert F., Wood, David A., Mehran, Roxana, Cairns, John A., and Mehta, Shamir R.

Abstract

IMPORTANCE: Recently, the Complete vs Culprit-Only Revascularization to Treat Multivessel Disease After Early PCI (percutaneous coronary intervention) for STEMI (ST-segment elevation myocardial infarction [MI]) (COMPLETE) trial showed that angiography-guided PCI of the nonculprit lesion with the goal of complete revascularization reduced cardiovascular (CV) death or new MI compared with PCI of the culprit lesion only in STEMI. Whether complete revascularization also reduces CV mortality is uncertain. Moreover, whether the association of complete revascularization with hard clinical outcomes is consistent when fractional flow reserve (FFR)– and angiography-guided strategies are used is unknown. OBJECTIVE: To determine through a systematic review and meta-analysis (1) whether complete revascularization is associated with decreased CV mortality and (2) whether heterogeneity in the association occurs when FFR- and angiography-guided PCI strategies for nonculprit lesions are performed. DATA SOURCES: A systematic search of MEDLINE, Embase, ISI Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) from database inception to September 30, 2019, was performed. Conference proceedings were also reviewed from January 1, 2002, to September 30, 2019. STUDY SELECTION: English-language randomized clinical trials comparing complete revascularization vs culprit-lesion-only PCI in patients with STEMI and multivessel disease were included. DATA EXTRACTION AND SYNTHESIS: The combined odds ratio (OR) was calculated with the random-effects model using the Mantel-Haenszel method (sensitivity with fixed-effects model). Heterogeneity was measured using the I2 statistic. Publication bias was evaluated using the inverted funnel plot approach. Data were analyzed from October 2019 to January 2020. MAIN OUTCOMES AND MEASURES: Cardiovascular death and the composite of CV death or new MI. RESULTS: Ten randomized clinical trials involving 7030 unique patients were included. The weighted mean follow-up time was 29.5 months. Complete revascularization was associated with reduced CV death compared with culprit-lesion-only PCI (80 of 3191 [2.5%] vs 106 of 3406 [3.1%]; OR, 0.69 [95% CI, 0.48-0.99]; P = .05; fixed-effects model OR, 0.74 [95% CI, 0.55-0.99]; P = .04). All-cause mortality occurred in 153 of 3426 patients (4.5%) in the complete revascularization group vs 177 of 3604 (4.9%) in the culprit-lesion-only group (OR, 0.84 [95% CI, 0.67-1.05]; P = .13; I2 = 0%). Complete revascularization was associated with a reduced composite of CV death or new MI (192 of 2616 [7.3%] vs 266 of 2586 [10.3%]; OR, 0.69 [95% CI, 0.55-0.87]; P = .001; fixed-effects model OR, 0.69 [95% CI, 0.57-0.84]; P &lt; .001), with no heterogeneity in this outcome when complete revascularization was performed using an FFR-guided strategy (OR, 0.78 [95% CI, 0.43-1.44]) or an angiography-guided strategy (OR, 0.61 [95% CI, 0.38-0.97]; P = .52 for interaction). CONCLUSIONS AND RELEVANCE: In patients with STEMI and multivessel disease, complete revascularization was associated with a reduction in CV mortality compared with culprit-lesion-only PCI. There was no differential association with treatment between FFR- and angiography-guided strategies on major CV outcomes.

Published
2020
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42. Pentraxin-3 vs C-reactive protein and other prognostic biomarkers in acute coronary syndrome: A substudy of the Platelet Inhibition and Patients Outcomes (PLATO) trial

Author

Kontny, Frederic, Andersen, Thomas, Ueland, Thor, Åkerblom, Axel, Lakic, Tatevik G, Michelsen, Annika E, Aukrust, Pål, Bertilsson, Maria, Becker, Richard C, Himmelmann, Anders, James, Stefan K, Siegbahn, Agneta, Storey, Robert F, and Wallentin, Lars

Abstract

Aims: We investigated the dynamics, associations with patient characteristics, other biomarkers, and clinical outcomes of pentraxin 3 in acute coronary syndrome.Methods and results: In multivariate analyses, pentraxin 3 measured in 5154 patients randomised in the Platelet Inhibition and Patients Outcomes (PLATO) trial (NCT00391872) was compared with leukocytes, high-sensitivity C-reactive protein, interleukin-6, cystatin C, N-terminal prohormone brain natriuretic peptide, high-sensitivity troponin T and growth differentiation factor 15 concerning prediction of clinical outcome. Pentraxin 3 peaked earlier than high-sensitivity C-reactive protein and was more strongly correlated with N-terminal prohormone brain natriuretic peptide and high-sensitivity troponin T than with high-sensitivity C-reactive protein. The frequency of cardiovascular death, spontaneous myocardial infarction or stroke by quartiles of pentraxin 3 at admission was 6.1%, 7.3%, 9.7% and 10.7%, respectively (p<0.0001). The hazard ratio per 50% increase of pentraxin 3 was 1.13 (95% confidence interval: 1.07–1.19), p<0.0001. This association remained significant after stepwise adjustments for leukocytes/high-sensitivity C-reactive protein (1.09 (1.02–1.15)), p=0.009, interleukin-6 (1.07 (1.01–1.14)), p=0.026, and cystatin C (1.07 (1.00–1.13)), p=0.044, but not after adjustment for N-terminal prohormone brain natriuretic peptide, high-sensitivity troponin T and growth differentiation factor 15. Admission pentraxin 3 was also associated with several of the individual endpoint components (cardiovascular death/spontaneous myocardial infarction; p=0.008, cardiovascular death; p=0.026, and spontaneous myocardial infarction; p=0.017), but not with stroke. Pentraxin 3 measured in the chronic phase (i.e. at one month) was still predictive of the composite endpoint in univariate analysis (1.12 (1.04–1.20) per 50% increase) p=0.0024, but not after adjustment for the other biomarkers.Conclusion: Admission level of pentraxin 3 is a modestly stronger predictor than high-sensitivity C-reactive protein and interleukin-6, but not than N-terminal prohormone brain natriuretic peptide or high-sensitivity troponin T, concerning cardiovascular outcome in acute coronary syndrome. Pentraxin 3 is more strongly correlated with N-terminal prohormone brain natriuretic peptide and high-sensitivity troponin T than with high-sensitivity C-reactive protein.

Published
2020
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43. Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry

Author

Dworeck, Christian, Redfors, Björn, Völz, Sebastian, Haraldsson, Inger, Angerås, Oskar, Råmunddal, Truls, Ioanes, Dan, Myredal, Anna, Odenstedt, Jacob, Hirlekar, Geir, Koul, Sasha, Fröbert, Ole, Linder, Rickard, Venetsanos, Dimitrios, Hofmann, Robin, Ulvenstam, Anders, Petursson, Petur, Sarno, Giovanna, James, Stefan, Erlinge, David, and Omerovic, Elmir

Abstract

Objectives The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.Methods We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect.Results During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial accessand 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55–0.88, P= 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25–0.79, P= 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24–0.73, P= 0.002).Conclusions In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.

Published
2020
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44. Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Author

Capodanno, Davide, Bhatt, Deepak L., Eikelboom, John W., Fox, Keith A. A., Geisler, Tobias, Michael Gibson, C., Gonzalez-Juanatey, Jose Ramon, James, Stefan, Lopes, Renato D., Mehran, Roxana, Montalescot, Gilles, Patel, Manesh, Steg, P. Gabriel, Storey, Robert F., Vranckx, Pascal, Weitz, Jeffrey I., Welsh, Robert, Zeymer, Uwe, and Angiolillo, Dominick J.

Abstract

Advances in antiplatelet therapies for patients with cardiovascular disease have improved patient outcomes over time, but the challenge of balancing the risks of ischaemia and bleeding remains substantial. Moreover, many patients with cardiovascular disease have a residual risk of ischaemic events despite receiving antiplatelet therapy. Therefore, novel strategies are needed to prevent clinical events through mechanisms beyond platelet inhibition and with an acceptable associated risk of bleeding. The advent of non-vitamin K antagonist oral anticoagulants, which attenuate fibrin formation by selective inhibition of factor Xa or thrombin, has renewed the interest in dual-pathway inhibition strategies that combine an antiplatelet agent with an anticoagulant drug. In this Review, we highlight the emerging pharmacological rationale and clinical development of dual-pathway inhibition strategies for the prevention of atherothrombotic events in patients with different manifestations of cardiovascular disease, such as coronary artery disease, cerebrovascular disease and peripheral artery disease.

Published
2020
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47. Individual Patient Data Pooled Analysis of Randomized Trials of Bivalirudin versus Heparin in Acute Myocardial Infarction: Rationale and Methodology

Author

Bikdeli, Behnood, McAndrew, Thomas, Crowley, Aaron, Chen, Shmuel, Mehdipoor, Ghazaleh, Redfors, Björn, Liu, Yangbo, Zhang, Zixuan, Liu, Mengdan, Zhang, Yiran, Francese, Dominic P., Erlinge, David, James, Stefan K., Han, Yaling, Li, Yi, Kastrati, Adnan, Schüpke, Stefanie, Stables, Rod H., Shahzad, Adeel, Steg, Philippe Gabriel, Goldstein, Patrick, Frigoli, Enrico, Mehran, Roxana, Valgimigli, Marco, and Stone, Gregg W.

Published
2020
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48. Relationship between degree of heparin anticoagulation and clinical outcome in patients receiving potent P2Y12-inhibitors with no planned glycoprotein IIb/IIIa inhibitor during percutaneous coronary intervention in acute myocardial infarction: a VALIDATE-SWEDEHEART substudy.

Author

Sharma, Tania, Rylance, Rebecca, Karlsson, Sofia, Koul, Sasha, Venetsanos, Dimitrios, Omerovic, Elmir, Fröbert, Ole, Persson, Jonas, James, Stefan, and Erlinge, David

Abstract

Heparin is the preferred choice of anticoagulant in percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). An established dosage of heparin has not yet been determined, but treatment may be optimized through monitoring of activated clotting time (ACT). The aim of this study was to determine the relationship between heparin dose or ACT with a composite outcome of death, MI, or bleeding using data from the registry-based, randomized, controlled, and open-label VALIDATE-SWEDEHEART trial, although patients were not randomized to heparin dose in this substudy.

Published
2020
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49. Incidence and outcome of myocardial infarction treated with percutaneous coronary intervention during COVID-19 pandemic

Author

Mohammad, Moman A, Koul, Sasha, Olivecrona, Go¨ran K, Gо¨tberg, Matthias, Tydén, Patrik, Rydberg, Erik, Scherstén, Fredrik, Alfredsson, Joakim, Vasko, Peter, Omerovic, Elmir, Angerås, Oskar, Fro¨bert, Ole, Calais, Fredrik, Vo¨lz, Sebastian, Ulvenstam, Anders, Venetsanos, Dimitrios, Yndigegn, Troels, Oldgren, Jonas, Sarno, Giovanna, Grimfja¨rd, Per, Persson, Jonas, Witt, Nils, Ostenfeld, Ellen, Lindahl, Bertil, James, Stefan K, and Erlinge, David

Abstract

ObjectiveMost reports on the declining incidence of myocardial infarction (MI) during the COVID-19 have either been anecdotal, survey results or geographically limited to areas with lockdowns. We examined the incidence of MI during the COVID-19 pandemic in Sweden, which has remained an open society with a different public health approach fighting COVID-19.MethodsWe assessed the incidence rate (IR) as well as the incidence rate ratios (IRRs) of all MI referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR), during the COVID-19 pandemic in Sweden (1 March 2020–7 May 2020) in relation to the same days 2015–2019.ResultsA total of 2443 MIs were referred for coronary angiography during the COVID-19 pandemic resulting in an IR 36 MIs/day (204 MIs/100 000 per year) compared with 15 213 MIs during the reference period with an IR of 45 MIs/day (254 MIs/100 000 per year) resulting in IRR of 0.80, 95% CI (0.74 to 0.86), p<0.001. Results were consistent in all investigated patient subgroups, indicating no change in patient category seeking cardiac care. Kaplan-Meier event rates for 7-day case fatality were 439 (2.3%) compared with 37 (2.9%) (HR: 0.81, 95% CI (0.58 to 1.13), p=0.21). Time to percutaneous coronary intervention (PCI) was shorter during the pandemic and PCI was equally performed, indicating no change in quality of care during the pandemic.ConclusionThe COVID-19 pandemic has significantly reduced the incidence of MI referred for invasive treatment strategy. No differences in overall short-term case fatality or quality of care indicators were observed.

Published
2020
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50. Bleeding after antiplatelet therapy for the treatment of acute coronary syndromes: a review of the evidence and evolving paradigms

Author

Buccheri, Sergio, Capodanno, Davide, James, Stefan, and Angiolillo, Dominick J.

Abstract

ABSTRACTIntroduction: Potent platelet inhibition reduces the risk of thrombotic complications including myocardial infarction and death in patients with acute coronary syndrome (ACS). Targeting different pathways involved in thrombotic processes have synergistic effects and more effectively counteract thrombosis both in the acute and long-term following an ACS. Unavoidably, more potent platelet inhibition increases the risk of bleeding. In light of the adverse prognostic implications associated with bleeding, including increased mortality, safety aspects with antiplatelet therapy have gained increased importance.Areas covered: This review aims at describing the safety of different antiplatelet agents, particularly with regards to the risk of bleeding complications, used in the management of ACS patients. New bleeding reduction strategies to enhance the safety of antiplatelet therapy are also reviewed.Expert opinion: The final goal of a well-structured antiplatelet treatment strategy is that of tackling the spectrum of ischemic risk without compromising patient safety. A simple mnemonic rule for guiding therapeutic decisions in this complex clinical scenario can be summarized with the acronym ‘ABC’, meaning the sequential process of assessing, balancing and customizing treatment strategies in individual patients on the tradeoff between bleeding and ischemic risk. This approach is recommended for maximizing the ischemic benefits, while preserving safety, with the use of antiplatelet therapy.

Published
2019
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