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1.
Circulation ; 128(14): 1495-503, 2013 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-24002794

RESUMEN

BACKGROUND: The effect of ß-blockers on infarct size when used in conjunction with primary percutaneous coronary intervention is unknown. We hypothesize that metoprolol reduces infarct size when administered early (intravenously before reperfusion). METHODS AND RESULTS: Patients with Killip class II or less anterior ST-segment-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention within 6 hours of symptoms onset were randomized to receive intravenous metoprolol (n=131) or not (control, n=139) before reperfusion. All patients without contraindications received oral metoprolol within 24 hours. The predefined primary end point was infarct size on magnetic resonance imaging performed 5 to 7 days after STEMI. Magnetic resonance imaging was performed in 220 patients (81%). Mean ± SD infarct size by magnetic resonance imaging was smaller after intravenous metoprolol compared with control (25.6 ± 15.3 versus 32.0 ± 22.2 g; adjusted difference, -6.52; 95% confidence interval, -11.39 to -1.78; P=0.012). In patients with pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 0 to 1 flow, the adjusted treatment difference in infarct size was -8.13 (95% confidence interval, -13.10 to -3.16; P=0.0024). Infarct size estimated by peak and area under the curve creatine kinase release was measured in all study populations and was significantly reduced by intravenous metoprolol. Left ventricular ejection fraction was higher in the intravenous metoprolol group (adjusted difference, 2.67%; 95% confidence interval, 0.09-5.21; P=0.045). The composite of death, malignant ventricular arrhythmia, cardiogenic shock, atrioventricular block, and reinfarction at 24 hours in the intravenous metoprolol and control groups was 7.1% and 12.3%, respectively (P=0.21). CONCLUSIONS: In patients with anterior Killip class II or less ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, early intravenous metoprolol before reperfusion reduced infarct size and increased left ventricular ejection fraction with no excess of adverse events during the first 24 hours after STEMI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01311700. EUDRACT number: 2010-019939-35.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Cardiotónicos/uso terapéutico , Metoprolol/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Intervención Coronaria Percutánea , Premedicación , Antagonistas Adrenérgicos beta/administración & dosificación , Biomarcadores , Cardiotónicos/administración & dosificación , Terapia Combinada , Forma MB de la Creatina-Quinasa/sangre , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Insuficiencia Cardíaca/prevención & control , Humanos , Imagen por Resonancia Magnética , Masculino , Metoprolol/administración & dosificación , Persona de Mediana Edad , Infarto del Miocardio/patología , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Miocardio/patología , Necrosis , Método Simple Ciego , Volumen Sistólico/efectos de los fármacos , Terapia Trombolítica
2.
JACC Cardiovasc Interv ; 17(6): 756-767, 2024 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-38385926

RESUMEN

BACKGROUND: Intravascular lithotripsy (IVL) has demonstrated effectiveness in the treatment of calcified lesions in selected patients with stable coronary disease. OBJECTIVES: The authors sought to assess the performance of coronary IVL in calcified coronary lesions in a real-life, all comers, setting. METHODS: The REPLICA-EPIC18 study prospectively enrolled consecutive patients treated with IVL in 26 centers in Spain. An independent core laboratory performed the angiographic analysis and event adjudication. The primary effectiveness endpoint assessed procedural success (successful IVL delivery, final diameter stenosis <20%, and absence of in-hospital major adverse cardiovascular events [MACE]). The primary safety endpoint measured freedom from MACE at 30 days. A predefined substudy compared outcomes between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients. RESULTS: A total of 426 patients (456 lesions) were included, 63% of the patients presenting with ACS. IVL delivery was successful in 99% of cases. Before IVL, 49% of lesions were considered undilatable. The primary effectiveness endpoint was achieved in 66% of patients, with similar rates among CCS patients (68%) and ACS patients (65%). Likewise, there were no significant differences in angiographic success after IVL between CCS and ACS patients. The rate of MACE at 30 days (primary safety endpoint) was 3% (1% in CCS and 5% in ACS patients [P = 0.073]). CONCLUSIONS: Coronary IVL proved to be a feasible and safe procedure in a "real-life" setting, effectively facilitating stent implantation in severely calcified lesions. Patients with ACS on admission showed similar angiographic success rates but showed a trend toward higher 30-day MACE compared with patients with CCS. (REPLICA-EPIC18 study [Registry of Coronary Lithotripsy in Spain]; NCT04298307).


Asunto(s)
Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Litotricia , Calcificación Vascular , Humanos , Vasos Coronarios , Estudios Prospectivos , Resultado del Tratamiento , Corazón , Litotricia/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/terapia
4.
J Am Heart Assoc ; 7(19): e009444, 2018 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-30371302

RESUMEN

Background Ticagrelor use during acute coronary syndromes demonstrated a decrease in all-cause mortality in the PLATO (Platelet Inhibition and Patient Outcomes) trial. This effect has been attributed to a non-platelet-derived improvement in endothelial function. The aim of this study was to determine differences in the number of endothelial progenitor cells and/or circulating endothelial cells found in peripheral blood in patients treated with either ticagrelor or clopidogrel during non-ST-segment-elevation myocardial infarction. Methods and Results In this multicenter, randomized study ( NCT 02244710), patients were considered for inclusion after non-ST-segment-elevation myocardial infarction whenever they were P2Y12-inhibitor naïve. Ticagrelor and clopidogrel were allocated at a 1:1 ratio. Blood samples for determining endothelial progenitor cells and circulating endothelial cells were extracted before the antiplatelet loading dose, 48 hours after presentation of index symptoms, and 1 month after the event. A multichannel cytometer was used for optimal cell characterization. A total of 96 patients fulfilled the inclusion criteria. Circulating endothelial cell levels corrected by white blood cells were as follows at baseline, 48 hours, and 1 month: 44 (28-64), 50 (33-63), and 38 (23-62) cells/mL, respectively, for clopidogrel and 38 (29-60), 45 (32-85), and 35 (24-71) cells/mL, respectively, for ticagrelor ( P=0.6). Endothelial progenitor cell levels were 29 (15-47), 27 (15-33), and 18 (10-25) cells/mL, respectively, for clopidogrel and 20 (11-33), 22 (12-32), and 18 (11-29) cells/mL, respectively, for ticagrelor ( P=0.9). No differences in intraindividual changes were found. Conclusions Patients treated with ticagrelor during non-ST-segment-elevation myocardial infarction, in comparison to clopidogrel, showed similar levels of endothelial progenitor cells and circulating endothelial cells. These data suggest that the endothelial protective effect mediated by ticagrelor is not related to bone marrow physiology modulation. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 02244710.


Asunto(s)
Clopidogrel/administración & dosificación , Células Progenitoras Endoteliales/metabolismo , Endotelio Vascular/fisiopatología , Infarto del Miocardio sin Elevación del ST/tratamiento farmacológico , Ticagrelor/administración & dosificación , Vasodilatación/fisiología , Anciano , Electrocardiografía , Células Progenitoras Endoteliales/citología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Infarto del Miocardio sin Elevación del ST/metabolismo , Infarto del Miocardio sin Elevación del ST/fisiopatología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Pronóstico , Método Simple Ciego
5.
J Thorac Dis ; 9(2): E103-E108, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28275491

RESUMEN

Significant periprosthetic aortic regurgitation after transcatheter aortic valve implantation has become a major concern of this technique given its association with impaired survival. We report the successful closure of such defect using a vascular occlusion device with the creation of an arterio-arterial loop to gain enough support to advance the delivery sheath into de the left ventricle.

7.
Rev Esp Cardiol ; 59(3): 217-24, 2006 Mar.
Artículo en Español | MEDLINE | ID: mdl-16712745

RESUMEN

INTRODUCTION AND OBJECTIVES: An association has been reported between direct stenting in primary angioplasty and low incidences of the no-reflow phenomenon and distal embolization. The aims of this study were to determine the proportion of patients who can be treated by direct stent implantation and to identify factors that establish when the technique should be used in acute myocardial infarction in clinical practice. PATIENTS AND METHOD: This prospective descriptive and multicenter study (DISCO 3) included 189 patients. Angiographic reperfusion parameters were recorded and resolution of the ST-segment elevation was monitored. Adverse clinical events, such as death, non-fatal reinfarction and repeat revascularization of the culprit vessel, were recorded at discharge, and after one and six months. RESULTS: Direct stenting was performed in 56% of patients, and stenting after predilatation in 44%. The main predictors of direct stenting were short postinfarction delay, non-zero initial TIMI flow, and preinfarction angina. The most common reasons for balloon predilatation were TIMI flow zero on traversing the lesion with a guidewire (92%), involvement of a major bifurcation or tortuous vessel, and severe calcification. Indices of myocardial reperfusion were better with direct stenting: TIMI myocardial perfusion grade 2-3 flow was present in 84% vs 69% (P=.005), and > 70% ST-segment resolution occurred in 66% vs 42% (P=.003). No difference in adverse clinical events was found. CONCLUSIONS: Direct stenting is feasible for treating acute myocardial infarction in more than half of patients. The lesions should not be severely calcified nor involve tortuous vessels, and there should be sufficient flow following passage of a guidewire to define the lesion's characteristics.


Asunto(s)
Angioplastia Coronaria con Balón , Infarto del Miocardio/terapia , Stents , Anciano , Angiografía Coronaria , Circulación Coronaria , Interpretación Estadística de Datos , Ecocardiografía , Electrocardiografía , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Estudios Prospectivos , Factores de Tiempo
8.
Res Cardiovasc Med ; 5(2): e31388, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26949692

RESUMEN

INTRODUCTION: Coronary vessel perforation is one of the most feared complications of coronary angioplasty. The treatment of this complication relies mostly on the implantation of covered stents. However, due to their design, covered stents are difficult to advance in a tortuous or calcified vessel. CASE PRESENTATION: We present a case of a grade III coronary perforation in which the double guiding catheter technique helped us to deliver the graft stent. CONCLUSIONS: The double-guiding technique is useful in emergency situations to increase the safety and efficacy of sealing a coronary perforation.

9.
Int J Cardiol Heart Vasc ; 7: 58-60, 2015 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-28785646

RESUMEN

An 83-year-old high-risk gentleman diagnosed with severe symptomatic aortic stenosis was scheduled for TAVR. A 31 mm CoreValve was implanted but severe paravalvular leak was noted. A valve-in-valve procedure was performed. However, the valve frame was partially dislodged into de ascending aorta. We report our strategy to solve this severe leak after a failed valve-in-valve procedure.

10.
World J Cardiol ; 6(6): 424-33, 2014 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-24976914

RESUMEN

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them, prehospital diagnosis and direct transfer to the cath lab, by-passing the emergency department of hospitals, has emerged as an attractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.

11.
Curr Vasc Pharmacol ; 11(1): 74-99, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22724463

RESUMEN

In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed.


Asunto(s)
Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Stents/efectos adversos , Animales , Evaluación Preclínica de Medicamentos , Humanos
12.
Rev Port Cardiol ; 32(7-8): 593-9, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23896301

RESUMEN

INTRODUCTION: In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO). OBJECTIVE: To evaluate the current situation in the treatment of CTO (techniques and material) in our setting. METHODS: We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal. RESULTS: A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2±0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1±1.0, with a mean total stent length of 49±24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively. CONCLUSIONS: In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected.


Asunto(s)
Oclusión Coronaria/terapia , Stents Liberadores de Fármacos , Sirolimus/análogos & derivados , Sirolimus/administración & dosificación , Procedimientos Quirúrgicos Cardíacos/instrumentación , Procedimientos Quirúrgicos Cardíacos/métodos , Everolimus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
Thromb Res ; 130(3): e31-6, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22704077

RESUMEN

INTRODUCTION: Thrombolysis, as reperfusion therapy for ST segment elevation myocardial infarction (STEMI), induces a pro-thrombotic status with enhanced platelet activity; this study aims to evaluate P2Y12 platelet reactivity and response to clopidogrel in the post-thrombolysis scenario. MATERIALS AND METHODS: Observational, prospective study, including consecutive patients with elective angiography after thrombolytic therapy for STEMI. Every patient received antiplatelet therapy with loading doses of 250 mg aspirin and 300 mg clopidogrel on admission followed by 100mg aspirin and 75 mg clopidogrel daily. P2Y12-dependent platelet reactivity (expressed in P2Y12-Reaction Units, PRU) was assessed with VerifyNow® device on admission, daily after thrombolysis and pre-angiography. RESULTS: 41 patients fulfilled the inclusion criteria. Median time between thrombolysis and angiography was 2,5 days (IQR 1,8-4,1). Post-treatment platelet reactivity (PPR) showed poor correlation with time on clopidogrel treatment (r2=0.04) and reached a maximum value of 274 ± 84 PRU during the first 24h after thrombolysis (Day +1 determination). After this, values showed a progressive reduction until the point of angiography (249 ± 82 PRU), without significant differences between consecutive time-points (p=0,549). Inhibition of platelet aggregation (IPA) assessed as a percentage of P2Y12 receptor blockage was poor, increasing gradually from 0 ± 4% on admission to 11 ± 6% the day of the angiography (p=0,001). 71,4% of patients showed PPR ≥ 208 PRU during angiography. CONCLUSIONS: Platelet reactivity, as assessed by post-treatment P2Y12 mediated reactivity, is heightened after thrombolytic therapy during STEMI management. In this scenario, standard doses of clopidogrel did not achieve significant inhibition of ADP-mediated platelet reactivity.


Asunto(s)
Aspirina/administración & dosificación , Infarto del Miocardio/sangre , Infarto del Miocardio/tratamiento farmacológico , Activación Plaquetaria/efectos de los fármacos , Receptores Purinérgicos P2Y12/sangre , Ticlopidina/análogos & derivados , Clopidogrel , Quimioterapia Combinada , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Terapia Trombolítica/métodos , Ticlopidina/administración & dosificación , Resultado del Tratamiento
16.
J Invasive Cardiol ; 24(7): 320-3, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22781469

RESUMEN

BACKGROUND AND OBJECTIVES: Incomplete re-endothelialization of stents can be revealed as paradoxical vasoconstriction with endothelium-dependent vasodilators. As no consensus exists about the best method or agent, our objective is to analyze the response to different drugs in a coronary swine model. METHODS: Twenty-seven stents were implanted in 9 domestic swine. The vessel diameter of proximal and distal segments (≥5 mm) was assessed immediately post implantation. Different endothelium-dependent vasodilators were used: intracoronary (IC) acetylcholine, 20 µg (A2) and 40 µg (A4), IC serotonin (S), 100 µg, and isoproterenol (I), intravenous infusion. The results are presented as constriction (%) compared with maximal vasodilation with IC nitroglycerin (N, 200 µg). RESULTS: In 10 vessels (37%), A4 provoked an occlusive spasm. Acetylcholine induced a higher degree of vasoconstriction (A4, 42 ± 39%; A2, 16 ± 14%) than the rest of the agonists (S, 6 ± 12%; I, 6 ± 11%; P<.01). The constriction rate was not related to the induced hemodynamic changes. CONCLUSIONS: After focal endothelial denudation in a coronary swine model, the constriction rate induced by different endothelium-dependent vasodilators is highly variable. The highest value is observed after IC acetylcholine bolus. The constriction rate does not correlate with the observed hemodynamic changes.


Asunto(s)
Vasos Coronarios/fisiología , Endotelio Vascular/fisiología , Stents , Vasodilatadores/farmacología , Sistema Vasomotor/efectos de los fármacos , Sistema Vasomotor/fisiología , Acetilcolina/farmacología , Animales , Vasos Coronarios/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Endotelio Vascular/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Isoproterenol/farmacología , Modelos Animales , Nitroglicerina/farmacología , Serotonina/farmacología , Porcinos , Vasoconstricción/efectos de los fármacos , Vasoconstricción/fisiología , Vasodilatación/efectos de los fármacos , Vasodilatación/fisiología
17.
Tex Heart Inst J ; 38(1): 35-41, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21423466

RESUMEN

Although drug-eluting stents have reduced the restenosis rate, some patients are not good candidates for prolonged double-antiplatelet therapy. Our goal was to learn the results of implanting cobalt-chromium stents in long lesions of large vessels.All consecutive patients with ≥1 lesion treated with a cobalt-chromium stent ≥28 mm in length and ≥3.5 mm in diameter during a 12-month period in 2 centers were monitored clinically and angiographically to determine the clinical status, restenosis rate, pattern of restenosis, and need for revascularization.The series comprised 78 patients with 81 lesions, mean age, 62.6 ± 15.2 yr; diabetes mellitus,19.2%; and primary or rescue intervention, 20.6%. Target vessels were the left anterior descending coronary artery, 12 (14.8%); left circumflex coronary artery, 12 (14.8%); and right coronary artery, 57 (70.4%). The mean lesion length was 35.18 ± 12.65 mm. The proximal reference diameter after percutaneous coronary intervention was 3.64 ± 0.54 mm; the distal, 3.2 ± 0.43 mm; and the mean, 3.42 ± 0.44 mm. The mean stent length was 38.05 ± 12.78 mm (range, 28-90 mm). The binary restenosis rate was 23% (15/64), with pattern IB in 2 cases, IC in 5, II in 7, and IV in 1. Revascularization was needed in 6 patients.In treating long lesions of large vessels, we found that cobalt-chromium stents achieved a moderate rate of target-vessel restenosis and a low rate of repeat revascularization. The pattern of restenosis was focal in almost half of the cases, and, in most remaining cases, restenosis affected short segments of the vessel.


Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Aleaciones de Cromo , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/diagnóstico por imagen , Stents , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Reestenosis Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estudios Prospectivos , Diseño de Prótesis , España , Factores de Tiempo , Resultado del Tratamiento
18.
Rev Esp Cardiol ; 64(9): 745-51, 2011 Sep.
Artículo en Español | MEDLINE | ID: mdl-21700374

RESUMEN

INTRODUCTION AND OBJECTIVES: Drug-eluting stents are useful for preventing restenosis, but the patho-physiological processes involved in the proliferative response after implantation are still not known in detail. The aim of this study is to compare the coronary vascular histomorphometry after implanting drug-eluting stents and bare metal stents in a swine model. METHODS: Sixty stents were randomly implanted in 20 Large White female pigs with a ratio of baremetal/drug-eluting stents of 1:2. After 28 days, euthanasia and histomorphometry were performed. We defined the vessel injury score in accordance to whether the internal elastic lamina was intact or ruptured. RESULTS: There were no differences between drug-eluting stents and bare metal stents in the intact internal elastic lamina group regarding neointimal area or % restenosis (1.3 [1.1-2.2]) vs 2.0 [1.3-2.5] mm²; P=.6; and 14.0 [12.1-20.8] vs 22.2 [14.1-23.3] %; P=.5). We assessed statistically significant differences for the ruptured internal elastic lamina group, (neointimal area 1.2 [0.8-2.0] vs 2.9 [2.3-3.7] mm²; P=.001 and % restenosis 16.63 [11.2-23.5] vs 30.4 [26.4-45.7] %; P=.001). CONCLUSIONS: In our swine model, we did not find any differences between proliferative response of drug-eluting stents and bare metal stents when the internal elastic lamina is intact; differences are only found when vascular injury is deeper.


Asunto(s)
Reestenosis Coronaria/patología , Vasos Coronarios/patología , Stents Liberadores de Fármacos , Stents , Animales , Proliferación Celular/efectos de los fármacos , Femenino , Modelos Biológicos , Neointima/patología , Porcinos
20.
Thromb Res ; 124(6): 678-82, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19411094

RESUMEN

INTRODUCTION: A wide variability in the response to clopidogrel and magnitude of post-treatment platelet reactivity has been described. However, this has been demonstrated by light transmittance aggregometry, a method too laborious for daily practice. Point-of-care devices may overcome this limitation, but little is known on the predictive value of such measurements. Our objective was to determine the relationship between platelet reactivity and the incidence of myocardial damage following percutaneous coronary intervention (PCI) in patients with Non-ST-segment Elevation Acute Coronary Syndrome (NSTEACS). MATERIALS AND METHODS: This prospective study included 93 patients with NSTEACS and PCI. All patients received a loading dose of 300 mg of clopidogrel and 250 mg of aspirin. Myocardial damage was defined as any elevation above upper limit of normal or previous levels of troponin T, assessed every 6 h for at least 24 h following PCI. Platelet reactivity not related to clopidogrel (BASE reactivity), related to P2Y12 inhibition (P2Y12 reactivity) and inhibition of platelet aggregation (IPA) were assessed immediately pre-PCI with the VerifyNow device. RESULTS: Myocardial damage was detected in 60 patients (64.5%). Higher BASE reactivity was associated with myocardial damage (287.8+/-62.6 vs. 260+/-55.9 units, p=0.043) while a trend was found for P2Y12 reactivity (173.4+/-70.3 vs. 149.2+/-58.4 units, p=0.109). No relationship was detected for IPA. Multivariate logistic regression analysis confirmed that BASE reactivity (p=0.04) and P2Y12 reactivity (p=0.03) were independent predictors of myocardial damage. CONCLUSIONS: Platelet reactivity before PCI appears to be better predictor of myocardial damage than does response to clopidogrel.


Asunto(s)
Síndrome Coronario Agudo/sangre , Angioplastia Coronaria con Balón/métodos , Plaquetas/citología , Miocardio/patología , Ticlopidina/análogos & derivados , Síndrome Coronario Agudo/tratamiento farmacológico , Anciano , Aspirina/uso terapéutico , Plaquetas/metabolismo , Clopidogrel , Femenino , Corazón/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Agregación Plaquetaria , Estudios Prospectivos , Antagonistas del Receptor Purinérgico P2 , Receptores Purinérgicos P2Y12 , Ticlopidina/uso terapéutico
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