The study was conducted in five Czech tertiary cardiology centers. Results have surprisingly shown that aggressive non-selective approach to premedication (pre-treating all patients scheduled for coronary angiography) is not superior to a more cautious selective approach.
Background: Anticlotting agent clopidogrel is widely used as pre-treatment before planned percutaneous coronary intervention (PCI) due to the fact that it has been proven to reduce periprocedural ischemic complications (e.g. periprocedural myocardial infarction). However, vast majority of patients in the current interventional cardiology practice do not undergo planned PCI, but rather “ad-hoc“ PCI performed a few minutes after diagnostic coronary angiography (CAG). Whether clopidogrel should be administered as pre-treatment to all patients undergoing elective CAG with the aim to ensure therapeutic levels at the time of possible ad-hoc PCI is not known.
Methods: This randomized trial enrolled 1,028 patients in five participating hospitals in the Czech Republic. All patients underwent elective CAG, i.e. invasive imaging of their coronary arteries. On the day before CAG patients were randomized to group A (“nonselective” - clopidogrel 600 mg to all patients > 6 hours before CAG; n = 513) or group B (“selective” - clopidogrel 600 mg in the cath-lab after CAG, only to patients undergoing subsequent PCI; n = 515). Combined primary end-point was death / periprocedural myocardial infarction / stroke or transient ischemic attack / re-intervention within 7 days. Secondary end-points were troponin elevation, TIMI-flow after PCI, bleeding complications.
Results: Ad-hoc PCI (i.e. PCI immediately following CAG) was performed in 29% of study patients. and bypass surgery (CABG) in 12 % of patients (mostly after >7 days). Medical therapy was indicated in 59% of patients. Primary end-point occurred in 0,8% in both groups (n.s.). Bleeding complications occurred in 3,5% group A patients vs. 1,2% group B (p = 0,02). Periprocedural troponin elevation (i.e. very small infarction as a complication of the procedure) was detected in 2,7% group A vs. 3,0% group B (n.s.).
When only the subgroup of patients who underwent PCI was analyzed, primary end-point occurred in 1,3% group A vs. 2,2% group B (n.s.). Periprocedural troponin elevation was detected in 8,6% (group A) vs. 11,1% (group B, n.s.). Bleeding complications occurred in 7,2% (group A) vs. 0,7% (group B, p = 0,006) and reintervention within 7 days in 0,7% group A vs. 1,5% group B (n.s.).
Conclusion: Routine clopidogrel pretreatment before elective CAG is not justified – it increases the risk of bleeding complications, while the benefit on periprocedural infarction is not significant. Clopidogrel should be given only to patients with known CAG who undergo PCI and this can be done safely in the catheterization laboratory between the two procedures.
ESC Press Office | alfa
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Controlling electronic current is essential to modern electronics, as data and signals are transferred by streams of electrons which are controlled at high speed. Demands on transmission speeds are also increasing as technology develops. Scientists from the Chair of Laser Physics and the Chair of Applied Physics at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have succeeded in switching on a current with a desired direction in graphene using a single laser pulse within a femtosecond ¬¬ – a femtosecond corresponds to the millionth part of a billionth of a second. This is more than a thousand times faster compared to the most efficient transistors today.
Graphene is up to the job
At the productronica trade fair in Munich this November, the Fraunhofer Institute for Laser Technology ILT will be presenting Laser-Based Tape-Automated Bonding, LaserTAB for short. The experts from Aachen will be demonstrating how new battery cells and power electronics can be micro-welded more efficiently and precisely than ever before thanks to new optics and robot support.
Fraunhofer ILT from Aachen relies on a clever combination of robotics and a laser scanner with new optics as well as process monitoring, which it has developed...
Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.
A warming planet
Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.
The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...
Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...
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