Safety of the primary percutaneous coronary intervention strategy combining pre-hospital prasugrel, enoxaparin and in-hospital bivalirudin in acute ST-segment elevation myocardial infarction

Backround: The optimal antithrombotic treatment during a primary percutaneous coronary intervention (pPCI) is not known. This single center registry study aims to assess the safety of a novel antithrombotic regimen combining enoxaparine and prasugrel at presentation, followed by bivalirudin at the catheterisation laboratory. Methods: All consecutive patients who underwent a pPCI were collected prospectively. The primary endpoint was major bleeding within 30 days. The secondary endpoints were a composite of major adverse cardiovascular events (MACE) consisting of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, a new target vessel revascularisation and all-cause mortality at 30 days. Results: Ninety-nine out of the total of 390 patients were treated according to the new regimen (protocol-treated group). The rest received other antithrombotic treatment (non-protocol-treated group). The protocol-treated group had a lower risk than the non-protocol-treated group according to the GRACE ischaemic (112 vs. 124, p = 0.002) and CRUSADE bleeding scores (21 vs. 28, p <0.0001). The incidences of bleeding were similar: severe GUSTO or TIMI bleeding occurred in 0 % of the protocol-treated group and in 1.0 and 0.3 %, respectively, of the other group (p = 0.311 for GUSTO and p = 0.559 for TIMI). The incidence of MACE in the groups was 6.1 and 10.7 %, respectively (p = 0.178). The respective incidences of all-cause mortality were 5.1 and 9.6 % (p = 0.158). Conclusions: Administration of the novel antithrombotic regimen seems to be safe.Peer reviewe

Lääkkeet sydäninfarktin hoidossa : Statiinihoidon hyödyt ja haitat

Raportissa tarkastellaan lääkkeiden merkitystä sekä lääkehoidon vaikuttavuutta ja kustannuksia sydäninfarktin hoidossa. Tulokset antavat ymmärrystä siihen, miten lääkkeiden korvausjärjestelmässä tapahtuneet muutokset ovat vaikuttaneet sydäninfarktipotilaiden lääkkeiden käyttöön, mitä hyötyjä ja haittoja statiinien käytöllä on sekä miten käytön kustannusvaikuttavuutta voidaan arvioida arkielämässä. Tutkimus syventää PERFECT (PERFormance, Effectiveness and Cost of Treatment episodes) hankkeen lääkkeitä koskevaa tarkastelua. Tässä rekisteripohjaisiin tietoihin perustuvassa tutkimuksessa kehiteltäviä lääkehoidon kustannusten ja vaikuttavuuden analyysimenetelmiä voidaan soveltaa myös muihin potilasryhmiin. Raportti antaa uutta tietoa kaikille lääkehoidon merkityksestä, kustannuksista ja vaikuttavuudesta kiinnostuneille

Trends in treatment delays for patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

Peer reviewe

Ultra-acute increase in blood glucose during prehospital phase is associated with worse short-term and long-term survival in ST-elevation myocardial infarction

Peer reviewe

COVID-19-adenovirusvektorirokotteen aiheuttama hyytymishäiriö

Vertaisarvioitu.COVID-19-infektioiden estämiseen kehitetyt adenovirusvektorirokotteet aiheuttavat erittäin harvinaisena haittavaikutuksena vaikeita hyytymishäiriöitä, joissa kehittyy verihiutaleita aktivoivia vasta-aineita. Tilan kansainvälinen nimitys on vaccine-induced immune thrombotic thrombocytopenia (VITT) tai tromboottinen trombosytopeeninen oireyhtymä (TTS), jolle ominaisia ovat trombosytopenia, positiiviset verihiutaletekijä 4 (PF4) -hepariinivasta-aineet ilman hepariinin käyttöä sekä valtimo- ja laskimotukokset. Hyytymishäiriön nopea diagnosointi on tärkeää, sillä tilaan liittyy jopa 40 %:n kuolleisuus. Hoidon kulmakivet ovat antikoagulaatio muilla kuin hepariinivalmisteilla ja suonensisäisen immunoglobuliinin antaminen trombosyyttiaktivaatiota aiheuttavien vasta-aineiden syrjäyttämiseksi.Peer reviewe

Soluble triggering receptor expressed on myeloid cells-1 is a marker of organ injuries in cardiogenic shock : results from the CardShock Study

Aims Optimal outcome after cardiogenic shock (CS) depends on a coordinated healing response in which both debris removal and extracellular matrix tissue repair play a crucial role. Excessive inflammation can perpetuate a vicious circle, positioning leucocytes as central protagonists and potential therapeutic targets. High levels of circulating Triggering Receptor Expressed on Myeloid cells-1 (TREM-1), were associated with death in acute myocardial infarction confirming excessive inflammation as determinant of bad outcome. The present study aims to describe the association of soluble TREM-1 with 90-day mortality and with various organ injuries in patients with CS. Methods and results This is a post-hoc study of CardShock, a prospective, multicenter study assessing the clinical presentation and management in patients with CS. At the time of this study, 87 patients had available plasma samples at either baseline, and/or 48 h and/or 96-120 h for soluble TREM-1 (sTREM-1) measurements. Plasma concentration of sTREM-1 was higher in 90-day non-survivors than survivors at baseline [median: 1392 IQR: (724-2128) vs. 621 (525-1233) pg/mL, p = 0.008), 48 h (p = 0.019) and 96-120 h (p = 0.029). The highest tertile of sTREM-1 at baseline (threshold: 1347 pg/mL) was associated with 90-day mortality with an unadjusted HR 3.08 CI 95% (1.48-6.42). sTREM-1 at baseline was not associated to hemodynamic parameters (heart rate, blood pressure, use of vasopressors or inotropes) but rather with organ injury markers: renal (estimated glomerular filtration rate, p = 0.0002), endothelial (bio-adrenomedullin, p = 0.018), myocardial (Suppression of Tumourigenicity 2, p = 0.002) or hepatic (bilirubin, p = 0.008). Conclusion In CS patients TREM-1 pathway is highly activated and gives an early prediction of vital organ injuries and outcome. [GRAPHICS] .Peer reviewe

Meta-analysis of randomized trials on drug-eluting stents vs. bare-metal stents in patients with acute myocardial infarction

Aims To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction. Methods and results We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0-24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29-0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46-1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53-1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48-1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents. Conclusion The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stent