Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study.

BACKGROUND: The efficacy and safety of ticagrelor compared with clopidogrel in acute coronary syndrome has not previously been evaluated in an Eastern Asian population, which is recognized to have a different response to P2Y12 antagonists compared with the Caucasian population in real-life situations. METHODS: A multicenter retrospective pilot study was performed to evaluate 928 consecutive patients with acute coronary syndrome, receiving aspirin and one P2Y12 antagonist (324 ticagrelor or 604 clopidogrel). Using propensity score matching, 448 patients were selected and divided into two equal groups. Kaplan-Meier analysis was used to study patient survival and event-free status using the log-rank test. Independent covariates were identified using univariate in a multivariate Cox proportional hazard model. RESULTS: In the overall cohort, significant differences were observed for certain variables between the two groups. During the mean 164.3 (±116.4)-day follow-up in the overall cohort, ticagrelor treatment had no significant effect on the primary efficacy endpoint (myocardial infarction, stroke, or vascular death); however, in the matched cohort, ticagrelor showed a lower incidence of primary endpoint (hazard ratio: 0.56; 95% confidence interval: 0.30-1.04; p = 0.07) and stroke (hazard ratio: 0.15; 95% confidence interval: 0.02-1.24; p = 0.08) with marginal statistical significance, and a similar bleeding rate. The protective effect of ticagrelor treatment was consistent for all subgroups. More patients treated with ticagrelor experienced dyspnea (21.0% vs. 11.6%, p = 0.007), and P2Y12 antagonist treatment was consequently discontinued. CONCLUSION: Ticagrelor treatment could provide a marginally favorable effect at the expense of an increased risk of dyspnea in real-life situations. This pilot study provides a scientific basis to call for a larger, suitably powered Phase 4 prospective or observational study in this ethnic population.

Glycoprotein IIb/IIIa inhibitor (tirofiban) in acute ST-segment elevation myocardial infarction.

Studies have shown conflicting results for glycoprotein IIb/IIIa inhibitor (tirofiban) use in ST-segment elevation myocardial infarction (STEMI). The authors aimed to determine if an upstream conventional dose of tirofiban in addition to a standard treatment regimen improved coronary patency and clinical outcomes in patients with STEMI. A retrospective analysis of consecutive patients with STEMI, who underwent emergent percutaneous coronary intervention (PCI) in the authors' hospital from July 2000 to April 2006 was performed. All patients received loading doses of aspirin, clopidogrel or ticlopidine, and unfractionated heparin with or without tirofiban in the emergency department prior to PCI. It was found that adding a conventional dose of tirofiban to the standard treatment regimen prior to PCI did not improve coronary patency in STEMI patients. Tirofiban also failed to show favorable outcomes for 90 days of follow-up, but there was a favorable trend for short-term 30-day survival.

Transient left ventricular apical ballooning syndrome: the first series in Taiwanese patients.

Previously thought as exclusive in Japanese patients, cases of transient left ventricular apical ballooning from other countries have also been reported. The cause remains unknown. From January 1997 to December 2005, 25 patients presenting with signs and symptoms of acute myocardial infarction with normal coronary arteries were analyzed. In all, 10 patients fulfilled all the criteria for transient left ventricular apical ballooning. In all, 6 patients had chest pain and diaphoresis, 5 patients had ST segment elevation, 7 had T wave inversions, and 5 had QT prolongation; 6 patients had normal coronary arteries and 4 had insignificant stenosis. In all, 2 patients died of sepsis, whereas the rest recovered. This is the first series in Taiwanese patients. Our series showed male preponderance, and most patients recovered with supportive treatment. Without any delineating preangiographic feature differentiating it from acute myocardial infarction, any patient should be treated as a case of myocardial infarction until proven otherwise.

Angiographic and clinical outcomes of rosiglitazone in patients with type 2 diabetes mellitus after percutaneous coronary interventions: a single center experience.

A beneficial effect of thiazolidinediones includes the reduction of intermediate markers, suggesting a potential for reducing atherosclerosis and restenosis. The objective of this study was to determine if rosiglitazone (RSG) reduced the odds of restenosis and if RSG improved the odds of clinical outcomes after percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) patients. A total of 609 patients with 734 lesions were selected from the period between January 1, 2001 and January 31, 2004. These patients were divided into 2 groups: a "control" group representing patients seen between January 1, 2001 and September 2002 when RSG was not available in our hospital and a "RSG treatment" group representing patients seen between September 2002 and January 31, 2004 when RSG was available in our hospital. Thus, 213 patients with 253 lesions (1.19 L/P) were placed in the RSG group and 396 patients with 481 lesions (1.21 L/P) were placed in the control group. Subgroup analysis based on the PCI received had 88 patients in the RSG arm receiving balloon angioplasty and 125 patients receiving coronary stenting; the control group had 187 and 209 patients, respectively, in the subgroups. Primary endpoint was angiographic restenosis at 6 months, and secondary endpoints were death, myocardial infarction, and target lesion revascularization. More patients in the control group were insulin-requiring, had poorer left ventricular function, but had a larger preprocedural minimal lumen diameter (pre-MLD). At 6 months, restenosis and reocclusion rates were lower in the RSG group (P = .014 and P = .006, respectively). Twenty-nine patients died in the control group versus 1 in the RSG group (P

Intracoronary retrieval of the dehisced radiopaque ring of a guiding catheter: an unusual complication of coronary angioplasty.

The guiding catheter used in coronary intervention may be damaged or some parts could be dehisced during the procedure, producing adverse effects in the vascular tree. So much so that immediate surgery is usually indicated. We report a case with a dehisced radiopaque ring of the catheter during the procedure. It was retrieved percutaneously without thoracotomy.