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Background: Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking., Methods and results: A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504-29.745; P=0.193), 0.550 (95% CI 0.188-1.609; P=0.275), and 0.264 (95% CI 0.099-0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9-25.0 kg/m 2 had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145-0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip-BMI score (KBS = 2.5 × Killip category - | BMI - 24 |) was calculated to select the beneficial population. A KBS ≥2 was associated with significant mortality benefit, whereas a KBS <0 predicted increased 30-day mortality with tirofiban use., Conclusions: Survival benefit from peri-angioplasty tirofiban therapy for STEMI was positively correlated with the Killip class. Tirofiban should be used cautiously in either underweight or overweight patients. The novel KBS used in this study can guide peri-angioplasty use of adjunctive tirofiban in patients with STEMI undergoing primary angioplasty.

Background: Little information is available in Asia about the real-world practice of dual antiplatelet therapy (DAPT) duration for acute coronary syndrome (ACS) and its influence on clinical outcomes.Methods and Results:The Taiwan ACS STENT Registry was a prospective, multicenter study to observe ACS patients using clopidogrel-based DAPT after percutaneous coronary intervention (PCI). The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. Overall, 2,221 ACS patients (62 years, 83% men) were included. DAPT duration was ≤9 months in 935 (42.1%). The incidence of primary outcome was higher in patients receiving DAPT ≤9 months compared with those receiving DAPT >9 months at 1 year (3.5% vs. 1.6%, P=0.0026). The incidence of stent thrombosis (overall 0.5%) was similar between groups. Multivariable analysis showed that DAPT >9 months was associated with a significantly lower risk of primary outcome (odds ratio 0.725, 95% confidence interval 0.545-0.965)., Conclusions: Our data showed that short duration of DAPT (≤9 months) was common (42.1%) in Taiwan for ACS patients undergoing PCI. DAPT ≤9 months increased the risk of the primary outcome.

Background: There is conflicting information regarding the association between hyperuricemia and survival in STEMI patients. Our study examined the interaction between hyperuricemia and Killip class on mortality of STEMI patients., Methods: We analyzed 951 consecutive STEMI patients between February 2006 and September 2012. Hyperuricemia was defined as SUA of at least 7mg/dL in males and 6mg/dL in females. Killip class I patients were divided into hyperuricemia and normouricemia groups., Results: The Killip class I hyperuricemia and normouricemia groups had similar baseline and procedural characteristics, but the hyperuricemia group had significantly greater BMI, serum creatinine, and SUA, and a lower TIMI risk score (2, IQR: 1-4 vs. 3, IQR: 2-4, p=0.019). The hyperuricemia group also had greater 30-day and 1-year mortality rates (2.9% vs. 0.3%, p=0.022; 6.5% vs. 1.1%, p=0.002, respectively). However, hyperuricemia was not associated with mortality of patients in Killip classes II-IV or in the overall study population. Hyperuricemia was associated with increased mortality in subgroups of patients who were at least 65years-old, male, had BMI of 25kg/m 2 or less, were in Killip class I, without diabetes, and who did not receive intra-aortic balloon pump support. Hyperuricemia interacted with Killip class I in increasing the risk for 1-year mortality (p for interaction=0.038)., Conclusions: Hyperuricemia increased the 1-year mortality of STEMI patients in Killip class I, but not of patients in Killip classes II-IV. An interaction of hyperuricemia and Killip class significantly affects the mortality of STEMI patients., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: All guidelines recommend 12-month dual antiplatelet therapy (DAPT) for patients (pts) with acute coronary syndrome (ACS). In Asia, little information is available about the contemporary real world data for DAPT duration and its impact on clinical outcomes in ACS pts treated with percutaneous coronary intervention (PCI). Methods and Results: The Taiwan ACS Stent Registry was a prospective, multicenter, cohort study to observe clopidogrel-based DAPT in ACS pts treated with PCI from 2012 to 2015. The clinical outcomes in relation to DAPT duration (< 6, ≥ 6 to ≤ 9, and > 9 months [mos]) were compared. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI) and stroke. Stent thrombosis was the secondary endpoint. Overall, 2,222 ACS pts (62 yrs, 83% men) were included. Among them, 55% were ST-elevation MI, 36% received > 1 stent and 51% used drug-eluting stents. Overall, the mean duration of DAPT was 263±120 days. DAPT duration was < 6 mos in 23.9% of pts; 6 to 9 mos in 17.5%; and > 9 mos in 58.6%. At 1 yr follow-up, only 35.6% pts were treated with DAPT. The primary outcome occurred in 3.2%, 2.6% and 1.3% (p = 0.020) in pts with DAPT duration < 6, 6 to 9, and > 9 mos at 1 yr follow-up. Stent thrombosis occurred in 0.5% pts and there was no difference between the DAPT duration groups. Propensity score adjusted analysis was performed. Compared with < 6 mos, DAPT duration > 9 mos was associated with a lower risk of primary outcome (odds ratio [OR] 0.479, 95% confidence interval [CI] 0.238, 0.963), but not 6 to 9 mos (OR 0.952, 95% CI 0.425, 2.135). Multivariate logistic regression analysis showed that pts with diabetes, atrial fibrillation or received bare metal stent were more likely to have DAPT < 6 mos. The most common reason (72%) to stop clopidogrel before 12 mos was due to the Taiwan National Health Insurance reimbursement regulations which only cover 9 mos P2Y12 inhibitor after ACS. Conclusions: Only 35.6% pts with ACS treated with PCI received DAPT for 12 mos in Taiwan. DAPT ≤ 9 mos increased the risk of primary outcome. The reimbursement regulation is the most common cause to stop clopidogrel before 12 mos. [ABSTRACT FROM AUTHOR]

Abstract: Background: Thrombus aspiration has been shown to provide significant benefits during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of the current study was to evaluate the additional benefit of tirofiban to thrombus aspiration during primary PCI in myocardial reperfusion. Methods: 100 STEMI patients were randomized according to a 2×2 factorial design into 1 of the 4 groups: standard PCI, PCI with initial thrombus aspiration (IT), PCI with tirofiban infusion (TI), and PCI with both treatments (IT+TI). Results: The myocardial blush grade (MBG) 3 was achieved in 30.4%, 45.8%, 56% and 78.6% in the 4 groups respectively. More frequent MBG 3 (p =0.015) and complete (>70%) ST-segment resolution (STR, 67.9% vs. 41.7%, p =0.058) were observed in IT±TI group compared with IT group. If actuarial analysis was done after reassigning the 2 TI patients who crossed over to IT+TI, the difference between IT+TI and IT groups became more significant (MBG 3 rates: 76.7% vs. 45.8%, p =0.009; complete STR rates: 70% vs. 41.7%, p =0.036). Infusion of tirofiban resulted in improved MBG and STR (p =0.003 and 0.037, respectively). Thrombus aspiration resulted in improved MBG only (p =0.048) but not in STR. 6-month MACE (death, reinfarction, target lesion revascularization and stroke) was similar among groups (p =0.725). Conclusions: Tirofiban may augment thrombus aspiration therapy on myocardial reperfusion in primary PCI. The benefit of thrombus aspiration treatment without tirofiban might be less significant, especially on resolution of ST-segment elevation. [Copyright &y& Elsevier]