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257. WHITE BLOOD CELL COUNT AND MAJOR ADVERSE CARDIOVASCULAR EVENTS AFTER PERCUTANEOUS CORONARY INTERVENTION IN THE CONTEMPORARY ERA: INSIGHTS FROM THE PARIS STUDY

Author

Shah, Binita, primary, Baber, Usman, additional, Krucoff, Mitchell, additional, Aquino, Melissa, additional, Henry, Timothy, additional, Gibson, C. Michael, additional, Moliterno, David, additional, Steg, Philippe Gabriel, additional, Stuckey, Thomas, additional, Pocock, Stuart, additional, Dangas, George, additional, Ariti, Cono, additional, Witzenbichler, Bernhard, additional, Cohen, David, additional, Iakovou, Ioannis, additional, Sartori, Samantha, additional, Chieffo, Alaide, additional, Kini, Annapoorna, additional, Colombo, Antonio, additional, Weisz, Giora, additional, and Mehran, Roxana, additional

Published
2017
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259. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial

Author

Valgimigli, Marco, primary, Costa, Francesco, additional, Lokhnygina, Yuliya, additional, Clare, Robert M., additional, Wallentin, Lars, additional, Moliterno, David J., additional, Armstrong, Paul W., additional, White, Harvey D., additional, Held, Claes, additional, Aylward, Philip E., additional, Van de Werf, Frans, additional, Harrington, Robert A., additional, Mahaffey, Kenneth W., additional, and Tricoci, Pierluigi, additional

Published
2016
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260. Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Author

Angiolillo, Dominick J., primary, Goodman, Shaun G., additional, Bhatt, Deepak L., additional, Eikelboom, John W., additional, Price, Matthew J., additional, Moliterno, David J., additional, Cannon, Christopher P., additional, Tanguay, Jean-Francois, additional, Granger, Christopher B., additional, Mauri, Laura, additional, Holmes, David R., additional, Gibson, C. Michael, additional, and Faxon, David P., additional

Published
2016
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261. TCT-211 Incidence and Impact of Dual Antiplatelet Therapy Cessation on Clinical Outcomes in Patients with Renal Dysfunction: Insights from the PARIS Registry

Author

Chandrasekhar, Jaya, primary, Baber, Usman, additional, Sartori, Samantha, additional, Pinnelas, Rebecca, additional, Henry, Timothy, additional, Moliterno, David, additional, Cohen, David, additional, Weisz, Giora, additional, Kini, Annapoorna, additional, Bruckel, Jeffrey, additional, Pocock, Stuart, additional, Steg, Philippe Gabriel, additional, Witzenbichler, Bernhard, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, Iakovou, Ioannis, additional, Dangas, George, additional, Gibson, C. Michael, additional, Stuckey, Thomas, additional, and Mehran, Roxana, additional

Published
2016
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262. TCT-219 Influence Of Anemia On Physician-Recommended DAPT Discontinuation After Percutaneous Coronary Intervention

Author

Faggioni, Michela, primary, Chandrasekhar, Jaya, additional, Baber, Usman, additional, Vogel, Birgit, additional, Moliterno, David, additional, Henry, Timothy, additional, Steg, Philippe Gabriel, additional, Colombo, Antonio, additional, Gibson, Charles, additional, Pocock, Stuart, additional, Witzenbichler, Bernhard, additional, Chieffo, Alaide, additional, Cohen, David, additional, Weisz, Giora, additional, Kini, Annapoorna, additional, Dangas, George, additional, Krucoff, Mitchell, additional, and Mehran, Roxana, additional

Published
2016
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263. TCT-206 Tailoring the Intensity of Antiplatelet Pharmacotherapy to Ischemic and Bleeding Risk: A Cost Optimizing Simulation From PARIS

Author

Leisman, Daniel, primary, Baber, Usman, additional, Cohen, David, additional, Gibson, C. Michael, additional, Pocock, Stuart, additional, Henry, Timothy, additional, Steg, Philippe Gabriel, additional, Dangas, George, additional, Moliterno, David, additional, Witzenbichler, Bernhard, additional, Kini, Annapoorna, additional, Krucoff, Mitchell, additional, Bruckel, Jeffrey, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, and Mehran, Roxana, additional

Published
2016
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264. TCT-205 Incidence and clinical outcomes associated with DAPT discontinuation in complex PCI patients: From the PARIS registry

Author

Chandrasekhar, Jaya, primary, Baber, Usman, additional, Sartori, Samantha, additional, Aquino, Melissa, additional, Stuckey, Thomas, additional, Henry, Timothy, additional, Moliterno, David, additional, Cohen, David, additional, Steg, Philippe Gabriel, additional, Iakovou, Ioannis, additional, Bruckel, Jeffrey, additional, Pocock, Stuart, additional, Kini, Annapoorna, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, Witzenbichler, Bernhard, additional, Weisz, Giora, additional, Dangas, George, additional, Gibson, C. Michael, additional, and Mehran, Roxana, additional

Published
2016
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265. Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention.

Author

Sibbing, Dirk, Aradi, Daniel, Alexopoulos, Dimitrios, ten Berg, Jurrien, Bhatt, Deepak L., Bonello, Laurent, Collet, Jean-Philippe, Cuisset, Thomas, Franchi, Francesco, Gross, Lisa, Gurbel, Paul, Jeong, Young-Hoon, Mehran, Roxana, Moliterno, David J., Neumann, Franz-Josef, Pereira, Naveen L., Price, Matthew J., Sabatine, Marc S., So, Derek Y.F., and Stone, Gregg W.

Abstract

Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y 12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y 12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y 12 -inhibiting therapy. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early- vs. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention–treated patients is not recommended, recent data have led to an update in guideline recommendations that allow considering selective use of PFT for DAPT de-escalation. However, guidelines do not expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention. • Different P2Y 12 inhibitors have enabled physicians to contemplate individualized treatment regimens. • In selective scenarios, PFT and genotyping may be used as optional tools for guiding treatment. • Further studies on DAPT de-escalation and escalation are needed to refine existing treatment options. [ABSTRACT FROM AUTHOR]

Published
2019
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266. Incidence, predictors, and outcomes of DAPT disruption due to non-compliance vs. bleeding after PCI: insights from the PARIS Registry.

Author

Moalem, Kamilia, Baber, Usman, Chandrasekhar, Jaya, Claessen, Bimmer E., Sartori, Samantha, Aquino, Melissa, Dangas, George, Iakovou, Ioannis, Colombo, Antonio, Kini, Anapoorna, Gibson, Michael, Krucoff, Mitchell, Chieffo, Alaide, Moliterno, David, Witzenbichler, Bernhard, Pocock, Stuart, and Mehran, Roxana

Abstract

Background: The disruption of dual antiplatelet therapy (DAPT) due to non-compliance or bleeding is known to significantly increase the risk of adverse outcomes after percutaneous coronary intervention (PCI). However, it is currently unknown if there are differences in the predictors and clinical impact of disruption due to non-compliance compared with bleeding. Methods: The patterns of non-adherence to antiplatelet regimens in stented patients (PARIS) registry was an international, multicenter prospective study of PCI patients discharged on DAPT (aspirin + a P2Y12 receptor). We analyzed the incidence, patient characteristics, predictors, and outcomes in patients with DAPT disruption due to non-compliance as compared to DAPT disruption due to bleeding in the PARIS registry. Predictors of non-recommended disruption and bleeding disruption were assessed using logistic regression. Risks associated with disruption on major adverse cardiac events (MACE, a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, and target lesion revascularization) were analyzed using time-updated Cox regression over 2-year follow-up. Results: Out of 5018 patients, the rate of non-compliant DAPT disruption was 1.6% at 30 days (n = 79), 6.5% at 12 months (n = 328), and 9.1% at 2 years from PCI (n = 457). The rate of bleeding DAPT disruption was 0.6% at 30 days (n = 32), 3.1% at 12 months (n = 156), and 4.6% at 2 years (n = 229). Multivariate predictors of non-compliant disruption included female gender, history of smoking, acute coronary syndrome, and US patients which were associated with greater risk; and dyslipidemia and discharge PPI which were associated with lower risk. Multivariate predictors of bleeding disruption included older age, prior MI, and discharge warfarin which were associated with greater risk; and US region and intervention to the LAD which were associated with lower risk. Non-compliant disruption was associated with a significantly greater risk for MACE (HR 1.73, 95% CI 1.17–2.54, p = 0.006) and spontaneous myocardial infarction (HR 2.93, 95% CI 1.85–4.65, p < 0.001). Bleeding disruption was associated with a significantly greater risk for all-cause death (HR 1.93, 95% CI 1.22–3.08, p = 0.005). Conclusion: Approximately 1 in 10 patients disrupts DAPT due to non-compliance and 1 in 20 disrupts DAPT due to bleeding. Disruption due to non-compliance resulted in higher risk for ischemic events and disruption due to bleeding had higher subsequent mortality. These data warrant efforts to focus on patient education in those at high risk of non-compliance. [ABSTRACT FROM AUTHOR]

Published
2019
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269. Influence of labetalol on cocaine-induced coronary vasoconstriction in humans

Author

Boehrer, James D., Moliterno, David J., Willard, John E., Hillis, L. David, and Lange, Richard A.

Subjects
Labetalol -- Physiological aspects, Cocaine -- Physiological aspects, Vasoconstriction -- Drug therapy, Health, Health care industry
Abstract

PURPOSE: Although labetalol is sometimes given to patients with cocaine-associated chest pain, its influence on cocaine-induced coronary vasoconstriction is unknown. PATIENTS AND METHODS: In 15 patients (7 men, 8 women, aged 40 to 79 years) undergoing catheterization for chest pain, heart rate, mean arterial pressure, and coronary arterial area (by computer-assisted quantitative angiography) were measured (1) at baseline, (2) 15 minutes after intranasal cocaine, 2 mg/kg, then (3) 5 minutes after intravenous saline (n = 6) or labetalol, 0.25 mg/kg (n = 9). RESULTS: Of 40 coronary arterial segments analyzed, cocaine induced a 13% [+ or -] 10% (mean [+ or -] standard deviation) decrease in coronary arterial area in 32. Subsequently, no variable changed after saline administration. Although labetalol reduced mean arterial pressure (117 [+ or -] 14 mm Hg after cocaine, 110 [+ or -] 11 mm Hg after labetalol; p < 0.05), it induced no change in the coronary arterial area (3.47 [+ or -] 1.37 [mm.sup.2] after cocaine, 3.37 [+ or -] 1.32 [mm.sup.2] after labetalol; p = NS). CONCLUSION: Labetalol reverses the cocaine-induced rise in mean arterial pressure, but does not alleviate cocaine-induced coronary vasoconstriction.

Published
1993

271. Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry

Author

Chandrasekhar, Jaya, primary, Bansilal, Sameer, additional, Baber, Usman, additional, Sartori, Samantha, additional, Aquino, Melissa, additional, Farhan, Serdar, additional, Vogel, Birgit, additional, Faggioni, Michela, additional, Giustino, Gennaro, additional, Ariti, Cono, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, Kini, Annapoorna, additional, Saporito, Richard, additional, Michael Gibson, C., additional, Witzenbichler, Bernhard, additional, Cohen, David, additional, Moliterno, David, additional, Stuckey, Thomas, additional, Henry, Timothy, additional, Pocock, Stuart, additional, Dangas, George, additional, Gabriel Steg, P., additional, and Mehran, Roxana, additional

Published
2016
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272. Use of thienopyridine prior to presentation with non-ST-segment elevation acute coronary syndrome and association with safety and efficacy of vorapaxar: insights from the TRACER trial

Author

Harskamp, Ralf E, primary, Clare, Robert M, additional, Ambrosio, Giuseppe, additional, Held, Claes, additional, Lokhnygina, Yuliya, additional, Moliterno, David J, additional, White, Harvey D, additional, Aylward, Philip E, additional, Armstrong, Paul W, additional, Mahaffey, Kenneth W, additional, Harrington, Robert A, additional, Van de Werf, Frans, additional, Wallentin, Lars, additional, Strony, John, additional, and Tricoci, Pierluigi, additional

Published
2016
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273. Albuminuria and cardiovascular events in patients with acute coronary syndromes: Results from the TRACER trial

Author

Åkerblom, Axel, primary, Clare, Robert M., additional, Lokhnygina, Yuliya, additional, Wallentin, Lars, additional, Held, Claes, additional, Van de Werf, Frans, additional, Moliterno, David J., additional, Patel, Uptal D., additional, Leonardi, Sergio, additional, Armstrong, Paul W., additional, Harrington, Robert A., additional, White, Harvey D., additional, Aylward, Philip E., additional, Mahaffey, Kenneth W., additional, and Tricoci, Pierluigi, additional

Published
2016
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274. Effect of age on efficacy and safety of vorapaxar in patients with non–ST-segment elevation acute coronary syndrome: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial

Author

Armaganijan, Luciana V., primary, Alexander, Karen P., additional, Huang, Zhen, additional, Tricoci, Pierluigi, additional, Held, Claes, additional, Van de Werf, Frans, additional, Armstrong, Paul W., additional, Aylward, Philip E., additional, White, Harvey D., additional, Moliterno, David J., additional, Wallentin, Lars, additional, Chen, Edmond, additional, Harrington, Robert A., additional, Strony, John, additional, Mahaffey, Kenneth W., additional, and Lopes, Renato D., additional

Published
2016
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275. Time-Dependent Associations Between Actionable Bleeding, Coronary Thrombotic Events, and Mortality Following Percutaneous Coronary Intervention

Author

Baber, Usman, primary, Dangas, George, additional, Chandrasekhar, Jaya, additional, Sartori, Samantha, additional, Steg, Philippe Gabriel, additional, Cohen, David J., additional, Giustino, Gennaro, additional, Ariti, Cono, additional, Witzenbichler, Bernhard, additional, Henry, Timothy D., additional, Kini, Annapoorna S., additional, Krucoff, Mitchell W., additional, Gibson, C. Michael, additional, Chieffo, Alaide, additional, Moliterno, David J., additional, Weisz, Giora, additional, Colombo, Antonio, additional, Pocock, Stuart, additional, and Mehran, Roxana, additional

Published
2016
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276. Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents

Author

Yu, Jennifer, primary, Baber, Usman, additional, Mastoris, Ioannis, additional, Dangas, George, additional, Sartori, Samantha, additional, Steg, Philippe Gabriel, additional, Cohen, David J., additional, Giustino, Gennaro, additional, Chandrasekhar, Jaya, additional, Ariti, Cono, additional, Witzenbichler, Bernhard, additional, Henry, Timothy D., additional, Kini, Annapoorna S., additional, Krucoff, Mitchell W., additional, Gibson, C. Michael, additional, Chieffo, Alaide, additional, Moliterno, David J., additional, Colombo, Antonio, additional, Pocock, Stuart, additional, and Mehran, Roxana, additional

Published
2016
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277. Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents

Author

Baber, Usman, primary, Mehran, Roxana, additional, Giustino, Gennaro, additional, Cohen, David J., additional, Henry, Timothy D., additional, Sartori, Samantha, additional, Ariti, Cono, additional, Litherland, Claire, additional, Dangas, George, additional, Gibson, C. Michael, additional, Krucoff, Mitchell W., additional, Moliterno, David J., additional, Kirtane, Ajay J., additional, Stone, Gregg W., additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, Kini, Annapoorna S., additional, Witzenbichler, Bernhard, additional, Weisz, Giora, additional, Steg, Philippe Gabriel, additional, and Pocock, Stuart, additional

Published
2016
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278. Validation of BARC Bleeding Criteria in Patients With Acute Coronary Syndromes

Author

Vranckx, Pascal, primary, White, Harvey D., additional, Huang, Zhen, additional, Mahaffey, Kenneth W., additional, Armstrong, Paul W., additional, Van de Werf, Frans, additional, Moliterno, David J., additional, Wallentin, Lars, additional, Held, Claes, additional, Aylward, Philip E., additional, Cornel, Jan H., additional, Bode, Christoph, additional, Huber, Kurt, additional, Nicolau, José C., additional, Ruzyllo, Witold, additional, Harrington, Robert A., additional, and Tricoci, Pierluigi, additional

Published
2016
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279. Lack of Concordance Between Local Investigators, Angiographic Core Laboratory, and Clinical Event Committee in the Assessment of Stent Thrombosis

Author

Popma, Christopher J., primary, Sheng, Shi, additional, Korjian, Serge, additional, Daaboul, Yazan, additional, Chi, Gerald, additional, Tricoci, Pierluigi, additional, Huang, Zhen, additional, Moliterno, David J., additional, White, Harvey D., additional, Van de Werf, Frans, additional, Harrington, Robert A., additional, Wallentin, Lars, additional, Held, Claes, additional, Armstrong, Paul W., additional, Aylward, Philip E., additional, Strony, John, additional, Mahaffey, Kenneth W., additional, and Gibson, C. Michael, additional

Published
2016
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280. CLINICAL FEATURES AND OUTCOMES OF PATIENTS WITH TYPE 2 MYOCARDIAL INFARCTION: INSIGHTS FROM THE TRACER TRIAL

Author

Guimaraes, Patricia, primary, Leonardi, Sergio, additional, Huang, Zhen, additional, Wallentin, Lars, additional, Van de Werf, Frans, additional, Aylward, Philip, additional, Held, Claes, additional, Harrington, Robert, additional, Moliterno, David, additional, Armstrong, Paul, additional, White, Harvey, additional, Mahaffey, Kenneth, additional, and Tricoci, Pierluigi, additional

Published
2016
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281. Sudden Cardiac Death After Non–ST-Segment Elevation Acute Coronary Syndrome

Author

Hess, Paul L., primary, Wojdyla, Daniel M., additional, Al-Khatib, Sana M., additional, Lokhnygina, Yuliya, additional, Wallentin, Lars, additional, Armstrong, Paul W., additional, Roe, Matthew T., additional, Ohman, E. Magnus, additional, Harrington, Robert A., additional, Alexander, John H., additional, White, Harvey D., additional, Van de Werf, Frans, additional, Piccini, Jonathan P., additional, Held, Claes, additional, Aylward, Philip E., additional, Moliterno, David J., additional, Mahaffey, Kenneth W., additional, and Tricoci, Pierluigi, additional

Published
2016
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282. TRADEOFF BETWEEN MYOCARDIAL INFARCTION VERSUS BLEEDING TYPES ON MORTALITY AFTER ACUTE CORONARY SYNDROME: LESSONS FROM THE THROMBIN RECEPTOR ANTAGONIST FOR CLINICAL EVENT REDUCTION IN ACUTE CORONARY SYNDROME (TRACER) RANDOMIZED TRIAL

Author

Costa, Francesco, primary, Valgimigli, Marco, additional, Lokhnygina, Yuliya, additional, Clare, Robert, additional, Wallentin, Lars, additional, Moliterno, David, additional, Armstrong, Paul, additional, White, Harvey, additional, Held, Claes, additional, Aylward, Philip, additional, Van de Werf, Frans, additional, Harrington, Robert, additional, Mahaffey, Kenneth, additional, and Tricoci, Pierluigi, additional

Published
2016
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283. Arterial access site and outcomes in patients undergoing percutaneous coronary intervention with and without vorapaxar

Author

Déry, Jean‐Pierre, primary, Mahaffey, Kenneth W., additional, Tricoci, Pierluigi, additional, White, Harvey D., additional, Podder, Mohua, additional, Westerhout, Cynthia M., additional, Moliterno, David J., additional, Harrington, Robert A., additional, Chen, Edmond, additional, Strony, John, additional, Van de Werf, Frans, additional, Ziada, Khaled M., additional, Held, Claes, additional, Aylward, Philip E., additional, Armstrong, Paul W., additional, and Rao, Sunil V., additional

Published
2015
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284. Efficacy and Safety of Vorapaxar in Non–ST‐Segment Elevation Acute Coronary Syndrome Patients Undergoing Noncardiac Surgery

Author

van Diepen, Sean, primary, Tricoci, Pierluigi, additional, Podder, Mohua, additional, Westerhout, Cynthia M., additional, Aylward, Philip E., additional, Held, Claes, additional, Van de Werf, Frans, additional, Strony, John, additional, Wallentin, Lars, additional, Moliterno, David J., additional, White, Harvey D., additional, Mahaffey, Kenneth W., additional, Harrington, Robert A., additional, and Armstrong, Paul W., additional

Published
2015
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285. Abstract 16820: Albuminuria and Outcomes in Patients With Non-ST-segment Elevation Acute Coronary Syndromes: Results From the TRACER Trial

Author

Akerblom, Axel, primary, Clare, Robert, additional, Lokhnygina, Yuliya, additional, Wallentin, Lars, additional, Held, Claes, additional, Van de Werf, Frans, additional, Moliterno, David, additional, Patel, Uptal, additional, Leonardi, Sergio, additional, Armstrong, Paul, additional, Harrington, Robert, additional, White, Harvey, additional, Aylward, Philip, additional, Mahaffey, Kenneth, additional, and Tricoci, Pierluigi, additional

Published
2015
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287. TCT-225 Impact of Age on the Disruption of Dual Antiplatelet Therapy: Analysis from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented) Patients Registry

Author

Aoi, Shunsuke, primary, Yu, Jennifer, additional, Sartori, Samantha, additional, Baber, Usman, additional, Ariti, Cono, additional, Henry, Timothy D., additional, Cohen, David, additional, Moliterno, David J., additional, Pocock, Stuart J., additional, Gibson, C. Michael, additional, Krucoff, Mitchell, additional, Dangas, George, additional, Steg, Philippe G., additional, Weisz, Giora, additional, Witzenbichler, Bernhard, additional, and Mehran, Roxana, additional

Published
2015
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289. Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2018 Update.

Author

Angiolillo, Dominick J., Goodman, Shaun G., Bhatt, Deepak L., Eikelboom, John W., Price, Matthew J., Moliterno, David J., Cannon, Christopher P., Tanguay, Jean-Francois, Granger, Christopher B., Mauri, Laura, Holmes, David R., Gibson, C. Michael, and Faxon, David P.

Published
2018
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290. Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With Percutaneous Coronary Intervention.

Author

Tricoci, Pierluigi, Newby, L. Kristin, Clare, Robert M., Leonardi, Sergio, Gibson, C. Michael, Giugliano, Robert P., Armstrong, Paul W., Van de Werf, Frans, Montalescot, Gilles, Moliterno, David J., Held, Claes, Aylward, Philip E., Wallentin, Lars, Harrington, Robert A., Braunwald, Eugene, Mahaffey, Kenneth W., and White, Harvey D.

Abstract

Objectives In 13,038 patients with non–ST-segment elevation acute coronary syndrome undergoing index percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) and TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trials, the relationship between PCI-related myocardial infarction (MI) and 1-year mortality was assessed. Background The definition of PCI-related MI is controversial. The third universal definition of PCI-related MI requires cardiac troponin >5 times the 99th percentile of the normal reference limit from a stable or falling baseline and PCI-related clinical or angiographic complications. The definition from the Society for Cardiovascular Angiography and Interventions (SCAI) requires creatine kinase–MB elevation >10 times the upper limit of normal (or 5 times if new electrocardiographic Q waves are present). Implications of these definitions on prognosis, prevalence, and implementation are not established. Methods In our cohort of patients undergoing PCI, PCI-related MIs were classified using the third universal type 4a MI definition and SCAI criteria. In the subgroup of patients included in the angiographic core laboratory (ACL) substudy of EARLY ACS (n = 1,401) local investigator– versus ACL-reported angiographic complications were compared. Results Altogether, 2.0% of patients met third universal definition of PCI-related MI criteria, and 1.2% met SCAI criteria. One-year mortality was 3.3% with the third universal definition (hazard ratio: 1.96; 95% confidence interval: 1.24 to 3.10) and 5.3% with SCAI criteria (hazard ratio: 2.79; 95% confidence interval: 1.69 to 4.58; p < 0.001). Agreement between ACL and local investigators in detecting angiographic complications during PCI was overall moderate (κ = 0.53). Conclusions The third universal definition of MI and the SCAI definition were both associated with significant risk for mortality at 1 year. Suboptimal concordance was observed between ACL and local investigators in identifying patients with PCI complications detected on angiography. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRA·CER] [Study P04736]; NCT00527943 ; EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome [Study P03684AM2]; NCT00089895 ) [ABSTRACT FROM AUTHOR]

Published
2018
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291. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet...

Author

Baber, Usman, Li, Shawn X., Pinnelas, Rebecca, Pocock, Stuart J., Krucoff, Mitchell W., Ariti, Cono, Gibson, C. Michael, Steg, Philippe Gabriel, Weisz, Giora, Witzenbichler, Bernhard, Henry, Timothy D., Kini, Annapoorna S., Stuckey, Thomas, Cohen, David J., Iakovou, Ioannis, Dangas, George, Aquino, Melissa B., Sartori, Samantha, Chieffo, Alaide, and Moliterno, David J.

Abstract

Background--Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. Methods and Results--Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. Conclusions--Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD. [ABSTRACT FROM AUTHOR]

Published
2018
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292. Clinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial.

Author

Guimarães, Patrícia O., Leonardi, Sergio, Huang, Zhen, Wallentin, Lars, de Werf, Frans Van, Aylward, Philip E., Held, Claes, Harrington, Robert A., Moliterno, David J., Armstrong, Paul W., White, Harvey D., Alexander, Karen P., Lopes, Renato D., Mahaffey, Kenneth W., and Tricoci, Pierluigi

Abstract

Background: Type 2 myocardial infarction (MI) is characterized by an imbalance between myocardial blood supply and demand, leading to myocardial ischemia without coronary plaque rupture, but its diagnosis is challenging.Methods: In the TRACER trial, patients with non-ST-segment elevation acute coronary syndromes were included. We aimed to describe provoking factors, cardiac biomarker profiles, treatment patterns, and clinical outcomes of patients with type 2 MIs. MI events during trial follow-up were adjudicated by an independent clinical events classification committee (CEC) and were classified according to the Third Universal Definition of MI. Using available source documents retrieved as part of the CEC process, we performed a retrospective chart abstraction to collect details on the type 2 MIs. Cox regression models were used to explore the association between MI type (type 1 or type 2) and cardiovascular death.Results: Overall, 10.3% (n=1327) of TRACER participants had a total of 1579 adjudicated MIs during a median follow-up of 502 days (25th and 75th percentiles [IQR] 349-667). Of all MIs, 5.2% (n=82) were CEC-adjudicated type 2 MIs, occurring in 76 patients. The incidence of type 2 MI was higher in the first month following randomization, after which the distribution became more scattered. The most frequent potential provoking factors for type 2 MIs were tachyarrhythmias (38.2%), anemia/bleeding (21.1%), hypotension/shock (14.5%), and hypertensive emergencies (11.8%). Overall, 36.3% had a troponin increase >10× the upper limit of normal. Coronary angiography was performed in 22.4% (n=17) of patients during hospitalizations due to type 2 MIs. The hazard of cardiovascular death was numerically higher following type 2 MI (vs. no MI, adj. HR 11.82, 95% CI 5.71-24.46; P<.0001) than that of type 1 MI (vs. no MI, adj. HR 8.90, 95% CI 6.93-11.43; P<.0001).Conclusions: Type 2 MIs were more prevalent in the first month after ACS, were characterized by the presence of triggers and infrequent use of an invasive strategy, and were associated with a high risk of death. Further efforts are needed to better define the role and implications of type 2 MI in both clinical practice and research. [ABSTRACT FROM AUTHOR]

Published
2018
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294. Sex-Stratified Trends in Enrollment, Patient Characteristics, Treatment, and Outcomes Among Non–ST-Segment Elevation Acute Coronary Syndrome Patients

Author

Kragholm, Kristian, primary, Halim, Sharif A., additional, Yang, Qinghong, additional, Schulte, Phillip J., additional, Hochman, Judith S., additional, Melloni, Chiara, additional, Mahaffey, Kenneth W., additional, Moliterno, David J., additional, Harrington, Robert A., additional, White, Harvey D., additional, Armstrong, Paul W., additional, Ohman, E. Magnus, additional, Van de Werf, Frans, additional, Tricoci, Pierluigi, additional, Alexander, John H., additional, Giugliano, Robert P., additional, and Newby, L. Kristin, additional

Published
2015
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295. Glycoprotein IIb/IIIa Receptor Inhibitors in Combination With Vorapaxar, a Platelet Thrombin Receptor Antagonist, Among Patients With Non–ST-Segment Elevation Acute Coronary Syndromes (from the TRACER Trial)

Author

Cornel, Jan H., primary, Tricoci, Pierluigi, additional, Lokhnygina, Yuliya, additional, Moliterno, David J., additional, Wallentin, Lars, additional, Armstrong, Paul W., additional, Aylward, Philip E., additional, Clare, Robert M., additional, Chen, Edmond, additional, Leonardi, Sergio, additional, Van de Werf, Frans, additional, White, Harvey D., additional, Held, Claes, additional, Strony, John, additional, Mahaffey, Kenneth W., additional, and Harrington, Robert A., additional

Published
2015
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297. PATTERNS OF ADHERENCE TO DUAL ANTIPLATELET THERAPY IN PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING COMPLEX PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE PARIS REGISTRY

Author

Giustino, Gennaro, primary, Baber, Usman, additional, Yu, Jennifer, additional, Sartori, Samantha, additional, Ariti, Cono, additional, Pocock, Stuart, additional, Henry, Timothy, additional, Cohen, David, additional, Moliterno, David, additional, Kruckoff, Mitchell, additional, Kini, Annapoorna, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, and Mehran, Roxana, additional

Published
2015
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298. IMPACT OF AGE ON THE MODES OF DUAL ANTIPLATELET THERAPY CESSATION: ANALYSIS FROM THE PARIS (PATTERNS OF NON-ADHERENCE TO ANTI-PLATELET REGIMENS IN STENTED PATIENTS) REGISTRY

Author

Aoi, Shunsuke, primary, Yu, Jennifer, additional, Sartori, Samantha, additional, Baber, Usman, additional, Ariti, Cono, additional, Henry, Timothy, additional, Cohen, David, additional, Moliterno, David, additional, Pocock, Stuart, additional, Gibson, C. Michael, additional, Stuckey, Thomas, additional, Berger, Peter, additional, Iakovou, Ioannis, additional, Waksman, Ron, additional, Hermiller, James, additional, and Mehran, Roxana, additional

Published
2015
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300. Vorapaxar with or without clopidogrel after non–ST-segment elevation acute coronary syndromes: Results from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome trial

Author

Tricoci, Pierluigi, primary, Lokhnygina, Yuliya, additional, Huang, Zhen, additional, Van de Werf, Frans, additional, Cornel, Jan H., additional, Chen, Edmond, additional, Wallentin, Lars, additional, Held, Claes, additional, Aylward, Philip E., additional, Moliterno, David J., additional, Jennings, Lisa K., additional, White, Harvey D., additional, Armstrong, Paul W., additional, Harrington, Robert A., additional, Strony, John, additional, and Mahaffey, Kenneth W., additional

Published
2014
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