Objective:There is limited evidence regarding the choice of P2Y12 receptor inhibitors as a component of dual antiplatelet therapy in patients with left main(LM)disease undergoing percutaneous coronary intervention(PCI...Objective:There is limited evidence regarding the choice of P2Y12 receptor inhibitors as a component of dual antiplatelet therapy in patients with left main(LM)disease undergoing percutaneous coronary intervention(PCI).This study aimed to evaluate long-term clinical outcomes of ticagrelor-vs.clopidogrel-based dual antiplatelet therapy strategy in acute coronary syndrome(ACS)patients undergoing LM PCI.Methods:This is a post-hoc analysis from a prospective,single-center,real-world PCI registry.A total of 1,163 patients discharged post-ACS who underwent LM PCI and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study.The primary endpoint was ischemic events at 12 months,including cardiac death,myocardial infarction,or stroke.Secondary outcomes included all-cause death and Bleeding Academic Research Consortium types 2,3,and 5,and types 3 and 5 bleeding.Propensity score matching was used to adjust for bias due to confounders between the 2 groups.Results:The ticagrelor and clopidogrel groups comprised 529(45.49%)and 634(54.51%)patients,respectively.During the follow-up period,the rate of ischemic events was significantly lower with ticagrelor than with clopidogrel before(1.32%(7/529)vs.3.63%(23/634),P=0.013,6)and after propensity score matching(1.41%(6/425)vs.4.00%(17/425),P=0.020,1).The rates of all-cause death,Bleeding Academic Research Consortium-defined type 2,3,and 5 bleeding,and type 3 and 5 bleeding were similar between the ticagrelor group and clopidogrel group before or after propensity score matching adjustment(all P>0.05).Conclusion:Among patients with ACS undergoing LM PCI,ticagrelor use was associated with ischemic events benefit without excessive risk of bleeding at 12 months compared with clopidogrel.展开更多
Objective::Data comparing the outcomes of MiStent(Micell Technologies,Durham,North Carolina,USA)microcrystalline biodegradable polymer(BP)drug-eluting stent(DES)and those of another post-marketing BP-DES,TIVOLI(EssenT...Objective::Data comparing the outcomes of MiStent(Micell Technologies,Durham,North Carolina,USA)microcrystalline biodegradable polymer(BP)drug-eluting stent(DES)and those of another post-marketing BP-DES,TIVOLI(EssenTech,Beijing,China)are rare.This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent(SES)system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective,single-blinded,multicenter,randomized trial(NCT02448524),which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio.The primary endpoint was a non-inferiority comparison of in-stent late lumen loss(LLL)by quantitative coronary angiography at 9 months.The secondary endpoint was device-related clinical cardiovascular composite events(target lesion failure(TLF),composite of cardiac death,target vessel myocardial infarction(MI),and clinically driven target lesion revascularization)and 1-year outcomes.Results::A total of 428 patients(216 patients in the MiStent group and 212 patients in the TIVOLI group)were enrolled and included in an intention-to-treat analysis.MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months((0.23±0.37)mm vs.(0.34±0.48)mm,P for non-inferiority<0.001,P for superiority=0.02).Although without significant difference,the rate of TLF in MiStent was quantitatively lower than that in TIVOLI(3.70%vs.6.60%;P=0.17).Conclusion::Compared with TIVOLI BP-SES,the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.展开更多
To the Editor:Dual antiplatelet therapy(DAPT),which comprises aspirin plus a P2Y12 receptor inhibitor,is the standard approach for reducing cardiac and systemic ischemic events in individuals with coronary artery dise...To the Editor:Dual antiplatelet therapy(DAPT),which comprises aspirin plus a P2Y12 receptor inhibitor,is the standard approach for reducing cardiac and systemic ischemic events in individuals with coronary artery disease.[1]Although DAPT reduces ischemic episodes,it also increases the risk of bleeding.In individuals with acute coronary syndrome(ACS),bleeding incidents during hospitalization not only greatly increase the risk of in-hospital death but also increase the risk of long-term mortality and major adverse cardiovascular events.[2]Therefore,the management of DAPT must consider both bleeding and ischemic risks.Anemia is a frequently observed complication in individuals diagnosed with ACS.[3]Anemic patients have increased susceptibility to ischemia and bleeding events after percutaneous coronary intervention(PCI),especially in the case of ACS.[4]There are presently no particular guidelines for early antiplatelet treatment in anemic individuals with ACS receiving PCI.Therefore,the aim of our study was to assess the in-hospital effectiveness and safety of ticagrelor and clopidogrel in anemic ACS patients undergoing PCI.展开更多
Objective:Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study(THEMIS)filled an important data gap by showing a significant reduction of ischemic cardiovascular events in a ticagrelor plus as...Objective:Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study(THEMIS)filled an important data gap by showing a significant reduction of ischemic cardiovascular events in a ticagrelor plus aspirin cohort compared with placebo plus aspirin cohort among patients with coronary artery disease(CAD)and type 2 diabetes mellitus(T2DM)but without a history of myocardial infarction.This study aims to evaluate the applicability of the THEMIS results in a real-world clinical setting in China.Methods:This retrospective,observational cohort study used data from the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease(OPT-CAD)study which enrolled participants who were hospitalized between November 2012 and December 2013.The 24-month cumulative incidence of major adverse cardiovascular event(MACE),major bleeding,and all-cause death in patients with T2DM and CAD(T2DM-CAD),T2DM and stable CAD(SCAD)(T2DM-SCAD),and T2DM and SCAD without prior myocardial infarction or stroke(THEMIS-like)were analyzed.Results:Data from 13,296 patients with CAD were included;the T2DM-CAD,T2DM-SCAD,and THEMIS-like cohorts comprised 3,344(25.2%),949(7.1%),and 509(3.8%)patients,respectively.The corresponding 24-month cumulative incidence of major bleeding was 38(1.1%),16(1.7%),and 8(1.6%),and that of MACEs was 250(7.5%),87(9.2%),and 29(5.7%),and all-cause death was 181(5.4%),84(8.9%),29(5.7%),respectively.The risk of MACE in the THEMIS-like cohort was approximate to that in the THEMIS trial(7.7%vs.8.5%in ticagrelor and placebo group,respectively).Conclusion:The incidence of MACE was substantial in the THEMIS-like cohort,suggesting that cardiovascular risk for future events correlates with the presence of cardiovascular disease across the CAD risk continuum.展开更多
基金supported by the Liaoning Provincial Science and Technology Joint Project(2021JH2/10300104)Science and Technology Program of Liaoning Province,China(2020JH1/10300002).
文摘Objective:There is limited evidence regarding the choice of P2Y12 receptor inhibitors as a component of dual antiplatelet therapy in patients with left main(LM)disease undergoing percutaneous coronary intervention(PCI).This study aimed to evaluate long-term clinical outcomes of ticagrelor-vs.clopidogrel-based dual antiplatelet therapy strategy in acute coronary syndrome(ACS)patients undergoing LM PCI.Methods:This is a post-hoc analysis from a prospective,single-center,real-world PCI registry.A total of 1,163 patients discharged post-ACS who underwent LM PCI and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study.The primary endpoint was ischemic events at 12 months,including cardiac death,myocardial infarction,or stroke.Secondary outcomes included all-cause death and Bleeding Academic Research Consortium types 2,3,and 5,and types 3 and 5 bleeding.Propensity score matching was used to adjust for bias due to confounders between the 2 groups.Results:The ticagrelor and clopidogrel groups comprised 529(45.49%)and 634(54.51%)patients,respectively.During the follow-up period,the rate of ischemic events was significantly lower with ticagrelor than with clopidogrel before(1.32%(7/529)vs.3.63%(23/634),P=0.013,6)and after propensity score matching(1.41%(6/425)vs.4.00%(17/425),P=0.020,1).The rates of all-cause death,Bleeding Academic Research Consortium-defined type 2,3,and 5 bleeding,and type 3 and 5 bleeding were similar between the ticagrelor group and clopidogrel group before or after propensity score matching adjustment(all P>0.05).Conclusion:Among patients with ACS undergoing LM PCI,ticagrelor use was associated with ischemic events benefit without excessive risk of bleeding at 12 months compared with clopidogrel.
文摘Objective::Data comparing the outcomes of MiStent(Micell Technologies,Durham,North Carolina,USA)microcrystalline biodegradable polymer(BP)drug-eluting stent(DES)and those of another post-marketing BP-DES,TIVOLI(EssenTech,Beijing,China)are rare.This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent(SES)system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective,single-blinded,multicenter,randomized trial(NCT02448524),which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio.The primary endpoint was a non-inferiority comparison of in-stent late lumen loss(LLL)by quantitative coronary angiography at 9 months.The secondary endpoint was device-related clinical cardiovascular composite events(target lesion failure(TLF),composite of cardiac death,target vessel myocardial infarction(MI),and clinically driven target lesion revascularization)and 1-year outcomes.Results::A total of 428 patients(216 patients in the MiStent group and 212 patients in the TIVOLI group)were enrolled and included in an intention-to-treat analysis.MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months((0.23±0.37)mm vs.(0.34±0.48)mm,P for non-inferiority<0.001,P for superiority=0.02).Although without significant difference,the rate of TLF in MiStent was quantitatively lower than that in TIVOLI(3.70%vs.6.60%;P=0.17).Conclusion::Compared with TIVOLI BP-SES,the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.
基金This study was supported by the China National Key R&D Project (contract No. 2022YFC2503500)The CCC-ACS project is a program of the AHA and the CSC. The AHA received funding from Pfizer through an independent grant for learning and change and Astra-Zeneca as a quality improvement initiative.
文摘To the Editor:Dual antiplatelet therapy(DAPT),which comprises aspirin plus a P2Y12 receptor inhibitor,is the standard approach for reducing cardiac and systemic ischemic events in individuals with coronary artery disease.[1]Although DAPT reduces ischemic episodes,it also increases the risk of bleeding.In individuals with acute coronary syndrome(ACS),bleeding incidents during hospitalization not only greatly increase the risk of in-hospital death but also increase the risk of long-term mortality and major adverse cardiovascular events.[2]Therefore,the management of DAPT must consider both bleeding and ischemic risks.Anemia is a frequently observed complication in individuals diagnosed with ACS.[3]Anemic patients have increased susceptibility to ischemia and bleeding events after percutaneous coronary intervention(PCI),especially in the case of ACS.[4]There are presently no particular guidelines for early antiplatelet treatment in anemic individuals with ACS receiving PCI.Therefore,the aim of our study was to assess the in-hospital effectiveness and safety of ticagrelor and clopidogrel in anemic ACS patients undergoing PCI.
基金supported by grants from the National Key Research and Development Program of China(2022YFC2503500 and 2022YFC2503504)and a research grant AstraZeneca。
文摘Objective:Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study(THEMIS)filled an important data gap by showing a significant reduction of ischemic cardiovascular events in a ticagrelor plus aspirin cohort compared with placebo plus aspirin cohort among patients with coronary artery disease(CAD)and type 2 diabetes mellitus(T2DM)but without a history of myocardial infarction.This study aims to evaluate the applicability of the THEMIS results in a real-world clinical setting in China.Methods:This retrospective,observational cohort study used data from the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease(OPT-CAD)study which enrolled participants who were hospitalized between November 2012 and December 2013.The 24-month cumulative incidence of major adverse cardiovascular event(MACE),major bleeding,and all-cause death in patients with T2DM and CAD(T2DM-CAD),T2DM and stable CAD(SCAD)(T2DM-SCAD),and T2DM and SCAD without prior myocardial infarction or stroke(THEMIS-like)were analyzed.Results:Data from 13,296 patients with CAD were included;the T2DM-CAD,T2DM-SCAD,and THEMIS-like cohorts comprised 3,344(25.2%),949(7.1%),and 509(3.8%)patients,respectively.The corresponding 24-month cumulative incidence of major bleeding was 38(1.1%),16(1.7%),and 8(1.6%),and that of MACEs was 250(7.5%),87(9.2%),and 29(5.7%),and all-cause death was 181(5.4%),84(8.9%),29(5.7%),respectively.The risk of MACE in the THEMIS-like cohort was approximate to that in the THEMIS trial(7.7%vs.8.5%in ticagrelor and placebo group,respectively).Conclusion:The incidence of MACE was substantial in the THEMIS-like cohort,suggesting that cardiovascular risk for future events correlates with the presence of cardiovascular disease across the CAD risk continuum.
