State-of-the-Art Review: Percutaneous Coronary Intervention in Acute Coronary Syndrome DOI Creative Commons
Tayyab Shah, Alexander C. Fanaroff

Current Treatment Options in Cardiovascular Medicine, Journal Year: 2024, Volume and Issue: 27(1)

Published: Dec. 30, 2024

Abstract Purpose of the Review This summarizes major trials from past year examining percutaneous coronary intervention (PCI) strategies and adjunct therapies in myocardial infarction. Recent Findings Significant progress has been made four areas: (1) mechanical circulatory support acute infarction with cardiogenic shock – demonstrate that a left ventricular assist device provides significant mortality benefit select patients. (2) Timing choice complete revascularization patients MI without earlier during index procedure or hospitalization. (3) Intravascular imaging highlight using optical coherence tomography intravascular ultrasound yields superior outcomes compared to angiographic guidance alone. (4) Dual Antiplatelet Therapy (DAPT) timing findings indicate stopping DAPT (within 1–3 months post-PCI) transitioning P2Y12 inhibitors is generally safe effective. Summary underscore evolving role advanced technologies optimized improving for patients, focus on individualized evidence-based care strategies.

Language: Английский

Contrastive learning with transformer for adverse endpoint prediction in patients on DAPT post-coronary stent implantation DOI Creative Commons
Fang Li, Zenan Sun, Ahmed Abdelhameed

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 11

Published: Jan. 13, 2025

Background Effective management of dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation is crucial for preventing adverse events. Traditional prognostic tools, such as rule-based methods or Cox regression, despite their widespread use and ease, tend to yield moderate predictive accuracy within predetermined timeframes. This study introduces a new contrastive learning-based approach enhance prediction efficacy over multiple time intervals. Methods We utilized retrospective, real-world data from the OneFlorida + Clinical Research Consortium. Our focused on two primary endpoints: ischemic bleeding events, with windows 1, 2, 3, 6, 12 months post-DES implantation. first an auto-encoder compress patient features into more manageable, condensed representation. Following this, we integrated Transformer architecture multi-head attention mechanisms focus amplify most salient features, optimizing representation better accuracy. Then, applied learning enable model further refine its capabilities by maximizing intra-class similarities distinguishing inter-class differences. Meanwhile, was holistically optimized using loss functions, ensure predicted results closely align ground-truth values various perspectives. benchmarked performance against three cutting-edge deep survival models, i.e., DeepSurv, DeepHit, SurvTrace. Results The final cohort comprised 19,713 adult patients who underwent DES than 1 month records after coronary stenting. demonstrated superior both events across months, time-dependent concordance (C td ) index ranging 0.88 0.80 0.82 0.77, respectively. It consistently outperformed baseline including SurvTrace, statistically significant improvement in C -index evaluated scenarios. Conclusion robust our underscores potential DAPT significantly. By delivering precise insights at points, method meets current need adaptive, personalized therapeutic strategies cardiology, thereby offering substantial value improving outcomes.

Language: Английский

Citations

1
Antiplatelet Therapy in Low-Platelet-Count Patients After Percutaneous Coronary Intervention for Acute Coronary Syndromes DOI Open Access
Francesco Paciullo, Paolo Gresele

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(3), P. 838 - 838

Published: Jan. 27, 2025

The risk of cardiovascular events increases considerably after an acute coronary syndrome (ACS), particularly in the first few months. Dual antiplatelet therapy represents mainstay secondary prevention during this period, but is associated with a not-negligible bleeding which, among other factors, influenced by platelet count. Thrombocytopenic patients may experience ACS, and several ACSs develop thrombocytopenia hospitalization: management antithrombotic setting challenge. Here, we review available evidence on use low counts ACS.

Language: Английский

Citations

1
Understanding Drug Interactions in Antiplatelet Therapy for Atherosclerotic Vascular Disease: A Systematic Review DOI Creative Commons

Xiangqian Huang,

Jiahao Song, Xiaoming Zhang

et al.

CNS Neuroscience & Therapeutics, Journal Year: 2025, Volume and Issue: 31(2)

Published: Feb. 1, 2025

Antiplatelet drugs are a cornerstone in managing atherosclerotic vascular disease (ASVD). However, their interactions with other medications present significant challenges to treatment efficacy and safety. Patients ASVD often require multiple regimens due complex comorbidities, which increases the risk of drug-drug (DDIs). These can lead drug resistance, reduced therapeutic outcomes, or adverse effects. A thorough understanding DDIs is crucial for optimizing patient care. This review aims explore clinical significance. mechanisms, implications antiplatelet therapy Additionally, it seeks identify future research directions advance personalized strategies improve outcomes. systematic literature was conducted using key databases, focusing on studies, mechanistic research, guidelines related DDIs. Findings were analyzed common interaction patterns, associated risks, management strategies. The identifies involving drugs, particularly anticoagulants, nonsteroidal anti-inflammatory proton pump inhibitors. primarily occur through pharmacokinetic such as alterations metabolism via cytochrome P450 enzymes, pharmacodynamic including synergistic antagonistic effects platelet inhibition. Clinically, increase bleeding risk, reduce efficacy, contribute cardiovascular Strategies mitigate these risks include individualized selection, dose adjustments, genetic testing, monitoring. Effective essential patient-specific approach, considering predispositions, concurrent medications, crucial. categorizes based settings underscores need further predictive biomarkers, pharmacogenomics, advanced monitoring techniques. significantly impact effectiveness safety therapy, necessitating comprehensive mechanisms implications. Future should focus developing approaches, integrating pharmacological minimize provides foundation advancing practice enhancing patients ASVD.

Language: Английский

Citations

1
Clopidogrel Monotherapy for Double-Risk Acute Coronary Syndrome DOI
Marco Valgimigli, Antonio Landi

JAMA Cardiology, Journal Year: 2024, Volume and Issue: 9(6), P. 532 - 532

Published: April 17, 2024

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Language: Английский

Citations

1
Comparison Between Mono VS Dual VS Triple Antiplatelet Therapy In Patients With Ischemic Heart Disease Undergoing PCI, A Network Meta-Analysis DOI
Ali Saad Al-Shammari, Ahmed Ibrahim, Laila Shalabi

et al.

Current Problems in Cardiology, Journal Year: 2024, Volume and Issue: 49(11), P. 102755 - 102755

Published: July 28, 2024

Language: Английский

Citations

1
The metabolic activation of and platelet response to vicagrel vary with P-glycoprotein deficiency, rather than P-glycoprotein inhibition, in mice DOI

Xue‐Mei Li,

Hao-Dong Li,

Yuan-Yuan Shao

et al.

Xenobiotica, Journal Year: 2024, Volume and Issue: 54(9), P. 759 - 769

Published: Aug. 10, 2024

This study aimed to determine changes in the hydrolysis of vicagrel, a substrate drug arylacetamide deacetylase (Aadac) and carboxylesterase 2 (Ces2), P-glycoprotein (P-gp)-deficient or P-gp-inhibited mice elucidate mechanisms involved.

Language: Английский

Citations

0
State-of-the-Art Review: Percutaneous Coronary Intervention in Acute Coronary Syndrome DOI Creative Commons
Tayyab Shah, Alexander C. Fanaroff

Current Treatment Options in Cardiovascular Medicine, Journal Year: 2024, Volume and Issue: 27(1)

Published: Dec. 30, 2024

Abstract Purpose of the Review This summarizes major trials from past year examining percutaneous coronary intervention (PCI) strategies and adjunct therapies in myocardial infarction. Recent Findings Significant progress has been made four areas: (1) mechanical circulatory support acute infarction with cardiogenic shock – demonstrate that a left ventricular assist device provides significant mortality benefit select patients. (2) Timing choice complete revascularization patients MI without earlier during index procedure or hospitalization. (3) Intravascular imaging highlight using optical coherence tomography intravascular ultrasound yields superior outcomes compared to angiographic guidance alone. (4) Dual Antiplatelet Therapy (DAPT) timing findings indicate stopping DAPT (within 1–3 months post-PCI) transitioning P2Y12 inhibitors is generally safe effective. Summary underscore evolving role advanced technologies optimized improving for patients, focus on individualized evidence-based care strategies.

Language: Английский

Citations

0