IL METABOLISMO DEL MIOCARDIO ISCHEMICO IBERNATO E STORDITO: DIFFERENZA TRA NECROSI E APOPTOSI

Descrizione del metabolismo cardiaco in condidioni di adattamento o maladattamento in varie condizioni patologiche. Differenziazione dei meccanismi della morte cellulare per necrosi e per apoptos

High-dose bolus tirofiban and sirolimus-eluting stent versus abciximab and bare metal stent in acute myocardial infarction (STRATEGY) study

none9Summary. Background: Primary bare metal stenting and abciximab infusion are currently considered the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). Sirolimus eluting stents (SES), compared to bare metal stent (BMS), greatly reduce the incidence of binary restenosis and target vessel revascularisation (TVR), but their use on a routine basis results in a significant increase in medical costs.With current European list prices, the use of tirofiban instead of abciximab would save enough money to absorb the difference between SES and BMS. Aim: To assess whether in patients with STEMI the combination of SES with high dose bolus (HDB) tirofiban results in a similar incidence of major cardiovascular events (MACE) but in a lower binary restenosis rate after six months compared to BMS and abciximab. Methods and Results: 160 patients are required to satisfy the primary composite end-point, including MACE and binary restenosis. The study is ongoing: the current paper focuses on the methodology and demography of the first 100 patients so far enrolled. Patients randomised to HDB tirofiban (n = 50, mean age: 62 ± 12, 40 males) and abciximab (n = 50, mean age: 63 ± 12, 38 males) do not differ for medical history, presentation profile, medications at discharge, angiographic profile and creatine-kinase MB-fraction at peak. Conclusions: The results of the trial will be available by the end of 2004: they will be crucial for the cardiologists to know whether the gold standard for AMI treatment should be reconsidered after the introduction of SES into the clinical practice.noneVALGIMIGLI M; PERCOCO G; CICCHITELLI G; MALAGUTTI P; CAMPO G; FERRARI F; BARBIERI D; ANSANI L; R. FERRARIValgimigli, M; Percoco, G; Cicchitelli, G; Malagutti, P; Campo, Gianluca Calogero; Ferrari, F; Barbieri, D; Ansani, L; Ferrari, Robert

New and old strategies to afford the liberal use of drug-eluting stents in real-life scenarios

Drug-eluting stents represent one of the most important improvements in interventional cardiology by decreasing the rate of restenosis dramatically. However, at present, cost constraints and a lack of incremental reimbursement have limited their utilization in daily practice in many countries, including Europe. Strategies to implement the liberal use of sirolimus-eluting stents (SES), especially in the primary percutaneous coronary intervention setting where the cost-effectiveness profile could be less favourable, without affecting medical expenditure are presented and discussed. To project the potential cost-effectiveness of SES-supported multivessel treatment compared with that of coronary artery bypass grafting, a decisionanalytical model was developed from a payer’s perspective on the basis of data derived from the current Italian health-care system