Contemporary View of the Acute Coronary Syndromes (Part I of II)
Inflammation and factors leading to plaque rupture. Low-molecular-weight heparin. Platelet glycoprotein IIb/IIIa therapy.
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Contemporary View of the Acute Coronary Syndromes (Part II of II)
Contemporary View of the Acute Coronary Syndromes (Part II of II) Acute Coronary Syndromes: Contemporary View of the Acute Coronary Syndromes (Part II of II) - Ali Moustapha, MD and *H. Vernon Anderson, MD The dilemma of invasive versus conservative strategies. In the Veterans Affairs Non-Q Wave Infarction Strategies In-Hospital (VANQWISH) trial,61,62 patients with a non-Q wave MI were randomized to an early ...
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Part II: Risk Stratification in Patients with Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Evidence-Based Review
Part II: Risk Stratification in Patients with Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Evidence-Based Review Acute Coronary Syndromes: Part II: Risk Stratification in Patients with Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Evidence-Based Review - Rami Doukky, MD and James E. Calvin, MD In last month? Event rates increased significantly as the TIMI risk score increased: 4.7% for risk score of 0/1; 8.3% for risk score of 2; 13.2% for risk ...
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Percutaneous Coronary Intervention in a Patient with von Willebrand?s Disease Presenting with an Acute Coronary Syndrome
The optimal management strategy for patients with von Willebrand?s disease presenting with acute coronary syndromes is unclear. We present a clinical case of percutaneous coronary intervention following an acute coronary syndrome in a man with von Willebrand?s disease. Other published case reports are reviewed. The central role of von Willebrand factor in the pathophysiology of acute coronary syndrome and the possible cardioprotective effects of low levels of the protein are discussed. Practical considerations regarding hemostasis and antiplatelet therapy are addressed. Finally, recommendations for the management of patients with von Willebrand?s disease presenting with acute coronary syndromes are suggested.
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Improving Acute Coronary Syndrome Care: The ACC/AHA Guidelines and Critical Pathways
Placing these two therapies side-by-side reveals that IIb/IIIa inhibition is a great acute therapy in high-risk patients, while platelet activation inhibitors (aspirin and clopidogrel) are beneficial in both short- and long-term treatment for all patients. Those who were treated with clopidogrel were probably the highest risk patients, as opposed to the routine low-risk patients. 14. Fox KAA, Mehta SR, Zhao F, Gersh B, Yusuf S. The risks versus benefits of clopidogrel treatment in acute ...
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Low-Molecular-Weight Heparins and Glycoprotein IIb/IIIa Inhibitors with Percutaneous Coronary Intervention in Acute Coronary Syndromes
Low-molecular-weight heparin versus placebo ACS studies. Low-molecular-weight heparin versus unfractionated heparin ACS studies. Trials comparing LMWHs other than enoxaparin with UFH have shown inconsistent results.
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Improved In-Hospital Outcomes in Acute Coronary Syndromes (Unstable Angina/Non-ST Segment Elevation Myocardial Infarction) Despite Similar TIMI Risk Scores
Background. The Thrombolysis In Myocardial Infarction (TIMI) Risk Score has been shown to predict prognosis in acute coronary syndromes (ACS) comprised of unstable angina (UA) and non-ST segment elevation myocardial infarction (STEMI). We sought to evaluate the impact of newer antiplatelet and antithrombotic therapies for ACS, such as glycoprotein IIb/IIIa inhibitors (GPI) and low molecular weight heparin (LMWH), on in-hospital outcomes over time in patients (pts) with similar TIMI risk scores. Methods. The baseline demographics and clinical outcomes of pts with ACS (UA and non-STEMI) in 1998 (Group 1998) and 2000 (Group 2000) at a single large university medical center were compared using a prospectively collected database. In-hospital major adverse cardiac events (MACE) included death, MI, or recurrent angina that resulted in urgent revascularization. Risk was estimated by utilizing the TIMI Risk Score, which uses 7 predictor variables: age > 65 years, at least 3 risk factors for coronary artery disease, prior coronary stenosis of >= 50%, ST segment deviation on EKG, severe angina, prior aspirin use, and elevated cardiac biomarkers. Results: Comparing Group 1998 (n = 563) and Group 2000 (n = 604), there was no difference between the mean TIMI Risk Score (2.90 ± 1.52 vs. 2.91 ± 1.52; p = 0.97), demonstrating a similar risk profile. Nevertheless, significant improvement in in-hospital MACE (9.1% vs. 2.8%; p < 0.001) was noted. The improvement in MACE was due to differences in rates of recurrent angina, without significant differences in death and myocardial infarction. This occurred temporally in association with a significant increase in GPI (1.0% vs. 8.3%; p < 0.01) and LMWH (0.0% vs. 15.6%; p < 0.001) use within 24 hours of presentation, and the increased utilization of intracoronary stenting (46.6% vs. 64.6%; p = 0.005), findings which were confirmed with multivariate analysis. Conclusion. Despite similar TIMI Risk Scores, the in-hospital outcomes of pts with ACS have improved over time. This temporal chang
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Long-Term Outcomes Based on Time-to-Angiography in Patients Admitted with Non-ST-Segment Elevation Acute Coronary Syndromes
Objective. We investigated the impact of the duration from hospital admission to coronary angiography on the outcome of patients admitted with non ST-segment elevation acute coronary syndromes (NSTE-ACS). Background. Invasive risk stratification in patients with acute coronary syndromes (ACS) has been shown to improve outcome in contemporary studies. It is unclear whether early coronary angiography is better than initial medical therapy with later angiography. Methods. We performed an analysis of patients admitted to a tertiary coronary intensive care unit (CICU) with NSTE-ACS and had coronary angiography performed during the same hospitalization. Patients were categorized into three groups based on the time-to-angiography: same-day, 1 to 2 days, and > 2 days. The baseline clinical features, angiography results, 30-day, 6-month cardiovascular outcome and 3-year mortality rate were compared between the groups before and after adjusting for confounding variables. Results. A total of 836 fulfilled the inclusion criteria. Patients undergoing angiography > 2 days had a higher incidence of 3-vessel disease (45.7% vs. 31.7%, p < 0.001), underwent less percutaneous interventions at the time of the angiography (41.6% vs. 56.7%, p < 0.001), and more frequent coronary artery bypass surgery (9.9% vs. 15.3%, p = 0.05). Patients undergoing late invasive risk stratification (> 2 days) had increased 3-year mortality (OR 2.12, 95% CI 1.03?4.35, p = 0.04) after adjusting for confounding variables. Conclusion. In patients with NSTE-ACS and no contraindication to angiography, delayed angiography of more than 2 days of presentation was associated with increased mortality at 3 years.
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Switching from Enoxaparin to Bivalirudin in Patients with Acute Coronary Syndromes without ST-Segment Elevation Who Undergo Percutaneous Coronary Intervention. Results from SWITCH ? A Multicenter Clinical Trial
ABSTRACT: Background. Enoxaparin is an established therapy for the treatment of patients with acute coronary syndrome (ACS), and bivalirudin is commonly used as the antithrombotic agent during percutaneous coronary intervention (PCI). This study was designed to examine the safety of switching from enoxaparin to bivalirudin in these patients. Methods. The Switching from Enoxaparin to Bivalirudin in Patients with Acute Coronary Syndromes without ST-segment Elevation Undergoing Percutaneous Coronary Intervention (SWITCH) trial was a prospective, open-label, multicenter study including 91 patients who presented with an ACS without ST-segment elevation, and who had received >/= 1 dose of enoxaparin (1 mg/kg SC) within the 12 hours prior to PCI. Patients were enrolled into 3 time categories: Group 1: 0?4; Group 2: 4?8; and Group 3: 8?12 hours from last enoxaparin dose to PCI. The primary endpoint of the study was major bleeding complications. Results. Baseline characteristics and average number of enoxaparin injections prior to PCI were similar in all 91 patients and among the groups. There was no occurrence of death, Q-wave myocardial infarction (MI), or acute revascularization in any group and no incidence of intracranial or retroperitoneal bleeding. The overall rate of major bleeding (7.7%) was comparable among groups (p = 0.39), as was the incidence of periprocedural non-Q-wave MI (overall 12%; p = 0.58), irrespective of the time interval between enoxaparin and bivalirudin administration. Conclusions. Switching from enoxaparin to bivalirudin for patients with ACS undergoing PCI appears to be clinically safe without increased risk of major bleeding complications, regardless of the time of enoxaparin administration, and is safe enough to warrant testing it in larger numbers.
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Why Don?t We Practice Evidence-based Medicine?
- Steven L. Goldberg Despite several studies showing an advantage of early treatment with clopidogrel in the patient presenting with acute coronary syndrome, or prior to percutaneous coronary intervention (PCI),1?6 this treatment is frequently not given early enough to achieve maximum benefit. The next question addresses the importance of early treatment with clopidogrel in patients presenting with an acute ...
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
Click Here for More Info.
Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
Birmingham, AL - Date: Friday, May 9, 2008 6:00pm EST -8:00 pm EST
This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
Non-Accredited
This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
Complimentary Accredited CME Program
This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
A Complimentary Accredited ON-DEMAND Webcast
This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
Accredited CD
This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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Webcast and Web Archives |
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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Release Date: December 8, 2006