Comparison of P2Y12 inhibitors for mortality and stent thrombosis in patients with acute coronary syndromes: Single center study of 10 793 consecutive ‘real-world’ patients

Three oral platelet P2Y₁₂ inhibitors, clopidogrel, prasugrel, and ticagrelor, are available for reducing the risk of cardiovascular death and stent thrombosis in patients with acute coronary syndromes (ACS). We sought to compare the efficacy of these antiplatelet drugs in contemporary practice.

Data were collected for 10 793 consecutive ACS patients undergoing coronary angiography at Sheffield, UK (2009–2015). Since prasugrel use was mostly restricted to the STEMI subgroup, clopidogrel and ticagrelor were compared for all ACS patients, and all three agents were compared in the STEMI subgroup. Differences in outcomes were evaluated at 12 months by KM curves and log-rank test after adjustment for independent risk factors.

Of 10 793 patients with ACS (36% STEMI), 43% (4653) received clopidogrel, 11% (1223) prasugrel and 46% (4917) ticagrelor, with aspirin for all. In the overall group, ticagrelor was associated with lower all-cause mortality compared with clopidogrel (adjusted hazard ratio (adjHR) 0.82, 95% confidence intervals (CI) 0.71–0.96, p = 0.01). In the STEMI subgroup, both prasugrel and ticagrelor were associated with a lower mortality compared with clopidogrel (prasugrel vs. clopidogrel: adjHR 0.65, CI 0.48–0.89, p = 0.007; ticagrelor vs. clopidogrel: adjHR 0.70, CI 0.61–0.99, p = 0.05). Of the 7595 patients who underwent PCI, 78 (1.0%) had definite stent thrombosis by 12 months. Patients treated with ticagrelor had a lower incidence of definite stent thrombosis compared with clopidogrel (0.6% vs. 1.1%; adjHR 0.51, CI 0.29–0.89, p = 0.03). In the STEMI subgroup, there was no significant difference between the three groups (ticagrelor 1.0%, clopidogrel = 1.5%, prasugrel = 1.6%; p = 0.29).

In conclusion, ticagrelor was superior to clopidogrel for reduction in both mortality and stent thrombosis in unselected invasively managed ACS patients. In STEMI patients, both ticagrelor and prasugrel were associated with lower mortality compared with clopidogrel, but there was no significant difference in the incidence of stent thrombosis.     

介入心脏病学知识（六）非冠状动脉经皮介入治疗

尽管大多数经皮介入治疗是针对冠状动脉的，在过去的20年里，非冠状动脉经导管治疗也取得了相当大的进展。在成年患者中，最常见的操作是球囊二尖瓣膜成形术，酒精间隔消融术和间隔缺损封堵术。     

Rapid development of fatal TB constrictive pericarditis after cardiac surgery

We report the case of a 75-year-old male of Asian origin who developed TB constrictive pericarditis less than 6 weeks after CABG. He had no history of active TB, but did show a strong Heaf test reaction in 1987, following a period of weight loss. This was thought to be indicative of previous infection and was not actively treated. Cases of postcardiac surgery constrictive pericarditis have been reported in the literature, but to our knowledge, there is no report of development of TB constrictive pericarditis in such a short period following surgery.     

The impact of smoking on mortality after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a retrospective cohort outcome study at 3 years

Journal of Thrombosis and Thrombolysis - The “smoker’s paradox”, where smokers have improved survival post-myocardial infarction, was predominantly observed in the thrombolytic...     

Dextrocardia and two‐vessel percutaneous intervention

Dextrocardia is rare and percutaneous intervention in such patients presents additional challenges to the operator. This report describes successful two‐vessel angioplasty and stenting, including a chronic, sub‐totally occluded proximal left anterior descending artery.