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COMFORTABLE AMI: New-generation DES shows benefit

29 Aug, 12 | by Alistair Lindsay

Drug-eluting stents (DES) with biodegradable polymers can allow controlled drug release followed by subsequent degradation of the polymer, leaving a in essence a bare-metal stent.  In patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (STEMI), this may prevent the delayed vessel healing that is thought to be caused at least in part by the persistence of durable polymer components. more…

Biodegradable polymer stent shows promise in LEADERS

29 Jan, 12 | by Alistair Lindsay

Drug eluting stents have reduced restenosis rates, and the need for further revascularisation after stenting, despite initial concerns over late stent thrombosis. This complication has been attributed to chronic inflammation and neoatherosclerosis induced by the durable polymers used in these stents. Biodegradable stents have been hypothesised to reduce this inflammatory burden, by degrading to leave a polymer/drug-free stent thereby removing the late risk of stent thrombosis. more…

No benefit from platelet testing post PCI

10 Apr, 11 | by Alistair Lindsay

Clopidogrel is a prodrug that needs to be converted into an active metabolite in order to be active, however wide interindividual variability has been noted both in the concentration of active metabolite and also platelet responsiveness.  The GRAVITAS (Gauging Responsiveness with A VerifyNow assay – Impact on Thrombosis and Safety) aimed to investigate the effect of high-dose vs standard-dose clopidogrel in patients with high on-treatment platelet reactivity after PCI. more…

Paclitaxel Stents Safe in STEMI

21 Jun, 09 | by Alistair Lindsay

The Harmonising Outcomes with Revascularisation and Stents in Acute Myocardial Infarction (HORIZONS-AMI) was a prospective open label, multi-centre controlled trial involving patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). It incorporated two factorial randomised phases to allow a comparison of the direct thrombin inhibitor bivalirudin alone with heparin plus glycoprotein IIb-IIIa inhibitor use and a comparison of paclitaxel eluting stents (PES) with bare metal stents (BMS). Two primary clinical end-points were pre-specified: ischaemia driven TLR (analysis powered for superiority) and a composite safety end-point of major adverse cardiovascular events consisting of death, reinfarction, stroke and stent thrombosis (powered for non-inferiority with a 3.0% margin). The major secondary end-point was angiographic evidence of restenosis at 13 months

Longer antiplatelet therapy gives good DES outcomes

14 Oct, 08 | by Alistair Lindsay

Recently an excess of acute adverse coronary events has been reported among diabetic patients treated with drug eluting coronary stents (DES) who received short-term (<6 months) dual antiplatelet therapy (Circulation 2007;115:1440-55). more…

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