Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes
Marco Valgimigli,Enrico Frigoli,Sergio Leonardi,Martina Rothenbühler,Andrea Gagnor,Paolo Calabrò,Stefano Garducci,Paolo Rubartelli,Carlo Briguori,Giuseppe Andò,Alessandra Repetto,Ugo Limbruno,Roberto Garbo,Paolo Sganzerla,Filippo Russo,Alessandro Lupi,Bernardo Cortese,Arturo Ausiello,Salvatore Ierna,Giovanni Esposito,Patrizia Presbitero,Andrea Santarelli,Gennaro Sardella,Ferdinando Varbella,Simone Tresoldi,Nicoletta De Cesare,Stefano Rigattieri,Antonio Zingarelli,Paolo Tosi,Arnoud W J van 't Hof,Giacomo Boccuzzi,Elmir Omerovic,Manel Sabaté,Dik Heg,Peter Jüni,Pascal Vranckx +35 more
TLDR
In patients with an acute coronary syndrome, the rates of major adverse cardiovascular events and net adverse clinical events were not significantly lower with bivalirudin than with unfractionated heparin.Abstract:
BACKGROUND Conflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome METHODS We randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion Primary outcomes for the comparison between bivalirudin and heparin were the occurrence of major adverse cardiovascular events (a composite of death, myocardial infarction, or stroke) and net adverse clinical events (a composite of major bleeding or a major adverse cardiovascular event) The primary outcome for the comparison of a post-PCI bivalirudin infusion with no post-PCI infusion was a composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events RESULTS The rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (103% and 109%, respectively; relative risk, 094; 95% confidence interval [CI], 081 to 109; P = 044), nor was the rate of net adverse clinical events (112% and 124%, respectively; relative risk, 089; 95% CI, 078 to 103; P = 012) Post-PCI bivalirudin infusion, as compared with no infusion, did not significantly decrease the rate of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (110% and 119%, respectively; relative risk, 091; 95% CI, 074 to 111; P = 034) CONCLUSIONS In patients with an acute coronary syndrome, the rates of major adverse cardiovascular events and net adverse clinical events were not significantly lower with bivalirudin than with unfractionated heparin The rate of the composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events was not significantly lower with a post-PCI bivalirudin infusion than with no post-PCI infusion (Funded by the Medicines Company and Terumo Medical; MATRIX ClinicalTrialsgov number, NCT01433627) abstr actread more
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2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
Borja Ibanez,Stefan James,Stefan Agewall,Manuel J. Antunes,Chiara Bucciarelli-Ducci,Héctor Bueno,Alida L.P. Caforio,Filippo Crea,John A. Goudevenos,Sigrun Halvorsen,Gerhard Hindricks,Adnan Kastrati,Mattie J. Lenzen,Eva Prescott,Marco Roffi,Marco Valgimigli,Christoph Varenhorst,Pascal Vranckx,Petr Widimský +18 more
TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published.
Journal ArticleDOI
2018 ESC/EACTS Guidelines on myocardial revascularization.
Miguel Sousa-Uva,Franz-Josef Neumann,Anders Ahlsson,Fernando Alfonso,Adrian P. Banning,Umberto Benedetto,Robert A. Byrne,Jean-Philippe Collet,Falk,Stuart J. Head,Peter Jüni,Adnan Kastrati,Akos Koller,Steen Dalby Kristensen,Josef Niebauer,Dimitrios J. Richter,Petar M. Seferovic,Dirk Sibbing,Giulio G. Stefanini,Stephan Windecker,Rashmi Yadav,Michael O. Zembala +21 more
TL;DR: Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chair person) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK).
Journal ArticleDOI
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Stephan Windecker,Philippe Kolh,Fernando Alfonso,Jean-Philippe Collet,Jochen Cremer,Volkmar Falk,Gerasimos Filippatos,Christian W. Hamm,Stuart J. Head,Peter Jüni,A. Pieter Kappetein,Adnan Kastrati,Juhani Knuuti,Ulf Landmesser,Günther Laufer,Franz-Josef Neumann,Dimitrios J. Richter,Patrick Schauerte,Miguel Sousa Uva,Giulio G. Stefanini,David P. Taggart,Lucia Torracca,Marco Valgimigli,William Wijns,Adam Witkowski +24 more
TL;DR: Neumann et al. as discussed by the authors proposed a task force to evaluate the EACTS Review Co-ordinator's work on gender equality in the context of women's reproductive health.
Journal ArticleDOI
2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Jean-Philippe Collet,Holger Thiele,Emanuele Barbato,Olivier Barthelemy,Johann Bauersachs,Deepak L. Bhatt,Paul Dendale,Maria Dorobantu,Thor Edvardsen,Thierry Folliguet,Chris P Gale,Martine Gilard,Alexander Jobs,Peter Jüni,Ekaterini Lambrinou,Basil S. Lewis,Julinda Mehilli,Emanuele Meliga,Béla Merkely,Christian Mueller,Marco Roffi,Frans H. Rutten,Dirk Sibbing,George C.M. Siontis +23 more
TL;DR: A correction has been published: European Heart Journal, ehaa895, https://doi.org/10.1093/eurheartj/ehaa-895.
Journal ArticleDOI
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
Borja Ibanez,Borja Ibanez,Stefan James,Stefan Agewall,Manuel J. Antunes,Chiara Bucciarelli-Ducci,Héctor Bueno,Alida L.P. Caforio,Filippo Crea,John A. Goudevenos,Sigrun Halvorsen,Gerhard Hindricks,Adnan Kastrati,Mattie J. Lenzen,Eva Prescott,Marco Roffi,Marco Valgimigli,Christoph Varenhorst,Pascal Vranckx,Petr Widimský +19 more
TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published, and the standard of care for these patients is considered to be good.
References
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ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
TL;DR: Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists as discussed by the authors, and the purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients
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Stefan James,Dan Atar,Luigi P. Badano,Carina Blomström Lundqvist,Michael A. Borger,Anthony H. Gershlick,Kurt Huber,Peter Jüni,Mattie J. Lenzen,Kenneth W. Mahaffey,Marco Valgimigli +10 more
TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
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ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
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Third universal definition of myocardial infarction
Kristian Thygesen,Joseph S. Alpert,Allan S. Jaffe,Maarten L. Simoons,Bernard R. Chaitman,Harvey D. White +5 more
TL;DR: Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that …
Journal ArticleDOI
An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
Maarten L. Simoons,Eric J. Topol,Robert M. Califf,Frans Van de Werf,Paul W. Armstrong,Philip Edmund Aylward,G.I. Barbash,Eric R. Bates,A. Betriu,James Chesebro,J Col,David de Bono,JM Gore,Alan Guerci,John R. Hampton +14 more
TL;DR: The findings of this large-scale trial indicate that accelerated t-PA given with intravenous heparin provides a survival benefit over previous standard thrombolytic regimens.
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