Primary Percutaneous Coronary Intervention (PPCI) has traditionally been performed with the use of boluses of unfractionated heparin administered throughout the procedure. The use of newer agents, such as enoxaparin administered intravenously throughout the procedure, has not previously been compared to this standard of therapy. […]
Category: Interventional cardiology
How appropriate is coronary intervention?
When is a PCI procedure “appropriate” and when is it not? The answer depends on how you define “appropriate”, and recently appropriate use criteria for coronary revascularisations have been jointly developed by six professional organisations, including the AHA and ACC. The aim of this study, therefore, was to assess the appropriateness of PCI in the […]
HORIZON-AMI: 3 year outcomes remain positive
The HORIZONS-AMI trials previously reported a reduction in major bleeding and net adverse clinical events in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and treated with bivalirudin, as apposed to the use of heparin and a glycoprotein IIb/IIIa inhibitor. In addition, if eligible, patients were randomised to receive a paclitaxel-eluting […]
PRECOMBAT: PCI viable for unprotected left main disease
The SYNTAX study, which randomised patients with complex severe coronary disease to either CABG or PCI, found that CABG remains a superior treatment option for the majority of these patients. However, in a substudy of patients who had left main stem (LMS) disease, SYNTAX suggested equipoise between the two treatments. Since then, the debate about […]
Medical therapy underused in patients undergoing PCI
Optimal medical therapy (OMT) has previously been shown to lead to similar rates of cardiovascular events as percutaneous coronary intervention (PCI) in patients with stable coronary artery disease. Most noticeably, the COURAGE trial showed that PCI did not improve patient survival or prevent myocardial infarction. However, it is also known that the findings of important […]
Erythropoietin fails to reduce myocardial damage in STEMI
Patients who survive STEMI often go on to develop infarct expansion and myocardial thinning which can lead to heart failure and, ultimately, death. In an attempt to limit this phenomenon, several agents have been proposed, amongst them erythropoietin. In addition to its effects on red blood cell production, erythropoietin also stimulates angiogenesis and apoptosis, and […]
Use of evidence-based treatments improves STEMI outcomes
Over the last two decades several new treatments, both pharmacological and mechanical, have become available for the treatment of ST-elevation myocardial infarction (STEMI). As a result, several rounds of national and international guidelines have been developed to guide the implementation of these evidence-based treatments in clinical practice. However, relatively few data are available on how […]
Percutaneous Treatment of Mitral Regurgitation
Just as percutaneous therapy for coronary artery disease has revolutionized the management of patients with atherosclerosis and offered an alternative to traditional surgical management, percutaneous treatments are now becoming established for valvular heart disease. While percutaneous aortic valves are becoming increasingly common-place, treatment options for mitral regurgitant disease remain limited. One such option in development […]
PPCI less effective in the elderly
In the Apex-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial, the novel anti-inflammatory agent Pexelizumab was not found to improve outcomes when given during PPCI. However, the study did enrol the largest group of patients 75 years or older with ST-segment elevation myocardial infarction to be treated with primary percutaneous coronary intervention (PPCI) in […]
No benefit from platelet testing post PCI
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 […]