Study showed 40 percent reduction of the degree of myocardial damage during percutaneous coronary intervention compared to standard care which translated into better outcomes after 30 days in patients treated in the experimental arm versus the conventional one.
Existing practice surrounding many cardiovascular medications, including anti-hypertensive and lipid-lowering agents, is based on the evaluation of response to therapy. In cases where ideal therapeutic targets (which have been identified through several previous studies) are not met in the single individual, there is evidence to support the need to intensify standard treatment so as to achieve better control of the cardiovascular risk factor under treatment (e.g. blood pressure or cholesterol levels) as this translates into a better outcome.
No such practice currently exists for anti-platelet agents. Current treatment strategies for patients with coronary artery disease ignore the individual response to antiplatelet agent(s), and likewise fail to identify therapeutic targets for platelet reactivity necessary to evaluate the intensity of treatment.
Yet, inhibition of platelet aggregation following standard oral antiplatelet agents (i.e. aspirin or clopidogrel), has limited data from dedicated trials addressing the long-term safety and efficacy of DES in high-risk subgroups like diabetics, and patients with ST and non ST segment elevation MI or complex lesions. Reaction vary greatly among healthy subjects and patients. Many previous studies have shown that poor response to oral antiplatelet agents increases 1.8-10-fold, the risk of thrombotic events, including myocardial infarction, particularly after coronary angioplasty.
It is unknown whether this reflects suboptimal platelet inhibition per se which might benefit from alternative/more potent antiplatelet agents. Studies aiming at improving outcomes while intensifying platelet inhibition in these patients who are poor responders to standard oral antiplatelet gents are critical to establishing a causal relationship between poor response to a standard anti-platelet regimen and worse outcome. This may help identifying patients who are at high risk for cardiovascular recurrences because they are not fully protected by standard medications. In these patients, the tailored use of alternative anti-platelet agents may provide better protection from cardiovascular complications.
We selected patients, based on results of a point-of-care assay (VerifyNow produced by Accumetrics, Inc., San Diego, CA, USA), undergoing elective percutaneous coronary intervention who were presenting with suboptimal response to either aspirin and/or clopidogrel (these two medications together are crucial to make percutaneous coronary intervention both effective and safe). Poor responders to either aspirin and/or clopidogrel were then randomly treated with standard care (placebo on top of aspirin and clopidogrel) or with the addition of a potent intravenous antiplatelet agents (tirofiban).
Neither the patients nor their doctors knew whether they were receiving the real or placebo treatment. We were primarily interested in evaluating the effect of treatment on the incidence of myocardial damage induced during percutaneous coronary intervention (periprocedural myocardial infarction). We showed that intensifying platelet inhibition with tailored infusion of tirofiban in this population results in a greater than 40 percent reduction of the degree of myocardial damage during percutaneous coronary intervention compared to standard care which translated into a better outcomes a 30 days in patients treated in the experimental arm versus the conventional one. Both patients being poor responsive to aspirin or to clopidogrel seem to derive the same benefit.
Jacqueline Partarrieu | alfa
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
18.10.2017 | Materials Sciences
18.10.2017 | Physics and Astronomy
18.10.2017 | Physics and Astronomy