Meta-analysis of Dual Antiplatelet Therapy Versus Monotherapy With P2Y12 Inhibitors in Patients After Percutaneous Coronary Intervention.
- 作者列表："Malik AH","Yandrapalli S","Shetty SS","Aronow WS","Cooper HA","Panza JA
:The optimal duration of dual antiplatelet therapy (DAPT) in the era of second-generation drug-eluting stents is a matter of considerable debate with more data suggesting a shorter period of DAPT is feasible. We performed a meta-analysis to evaluate DAPT compared with monotherapy with a P2Y12 inhibitor after a percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane Central were searched from inception to October 2019 to identify randomized controlled trials that compared outcomes of patients treated with either DAPT or monotherapy with a P2Y12 inhibitor following PCI. Primary outcomes of interest included major bleeding, ischemic events (myocardial infarction, stroke, stent thrombosis, major adverse cardiac events), and both all-cause and cardiovascular mortality. Event rates were extracted, and the Mantel-Haenszel fixed-effects model was used to perform a meta-analysis. Summary statistics are reported as odds ratios with 95% confidence intervals. Subgroup analyses were performed using the generic inverse method. We identified four trials with 29,089 randomized patients. Use of P2Y12 monotherapy was associated with 30% lower odds of major bleeding 0.70 (0.60-0.81; p <0.01). Ischemic and mortality outcomes were similar in the two groups. For the outcome of major bleeding the results favor the use of P2Y12 monotherapy in the subgroups of age, sex, diabetes, chronic kidney disease, acute coronary syndrome, and multivessel disease. The present meta-analysis provides the most updated data on the use of DAPT duration. Following an initial period of short-term DAPT, monotherapy with a P2Y12 inhibitor appears to be the superior strategy for optimization of bleeding and thrombotic risk after PCI.
第二代药物洗脱支架时代双重抗血小板治疗 (DAPT) 的最佳持续时间是一个相当有争议的问题，更多的数据表明较短的DAPT是可行的。我们进行了一项荟萃分析，以评估经皮冠状动脉介入治疗 (PCI) 后与P2Y12抑制剂单药治疗相比的DAPT。检索PubMed、Embase和Cochrane Central从开始至2019年10月，以确定比较PCI后接受DAPT或P2Y12抑制剂单药治疗患者结局的随机对照试验。关注的主要结局包括大出血、缺血性事件 (心肌梗死、卒中、支架内血栓形成、主要不良心脏事件) 以及全因和心血管死亡率.提取事件发生率，并使用Mantel-Haenszel固定效应模型进行荟萃分析。汇总统计报告为具有95% 置信区间的比值比。使用通用逆方法进行亚组分析。我们确定了4项试验，共29,089例随机患者。使用P2Y12单药治疗与30% 的大出血风险降低0.70 (0.60-0.81; p <0.01) 相关。两组的缺血性和死亡率结果相似。对于大出血的结果，结果支持在年龄、性别、糖尿病、慢性肾病、急性冠状动脉综合征和多支血管病变的亚组中使用P2Y12单一疗法。本荟萃分析提供了关于使用DAPT持续时间的最新数据。在短期DAPT的初始阶段之后，使用P2Y12抑制剂的单一疗法似乎是优化PCI后出血和血栓形成风险的优越策略。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.