Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

How to optimally prepare a patient for planned coronary angiography and subsequent angioplasty ?

03.09.2007
A Czech study compared two anti-clotting treatment regimens, currently used before coronary angiography / angioplasty to find the optimal balance between preventing ischemic versus bleeding complications of these procedures.

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
Further information:
http://www.escardio.org

More articles from Studies and Analyses:

nachricht The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A “cosmic snake” reveals the structure of remote galaxies

The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.

Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...

Im Focus: Visual intelligence is not the same as IQ

Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.

That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...

Im Focus: Novel Nano-CT device creates high-resolution 3D-X-rays of tiny velvet worm legs

Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. In PNAS, a team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional x-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analyzed the locomotory system of a velvet worm.

During a CT analysis, the object under investigation is x-rayed and a detector measures the respective amount of radiation absorbed from various angles....

Im Focus: Researchers Develop Data Bus for Quantum Computer

The quantum world is fragile; error correction codes are needed to protect the information stored in a quantum object from the deteriorating effects of noise. Quantum physicists in Innsbruck have developed a protocol to pass quantum information between differently encoded building blocks of a future quantum computer, such as processors and memories. Scientists may use this protocol in the future to build a data bus for quantum computers. The researchers have published their work in the journal Nature Communications.

Future quantum computers will be able to solve problems where conventional computers fail today. We are still far away from any large-scale implementation,...

Im Focus: Wrinkles give heat a jolt in pillared graphene

Rice University researchers test 3-D carbon nanostructures' thermal transport abilities

Pillared graphene would transfer heat better if the theoretical material had a few asymmetric junctions that caused wrinkles, according to Rice University...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Ecology Across Borders: International conference brings together 1,500 ecologists

15.11.2017 | Event News

Road into laboratory: Users discuss biaxial fatigue-testing for car and truck wheel

15.11.2017 | Event News

#Berlin5GWeek: The right network for Industry 4.0

30.10.2017 | Event News

 
Latest News

NASA detects solar flare pulses at Sun and Earth

17.11.2017 | Physics and Astronomy

NIST scientists discover how to switch liver cancer cell growth from 2-D to 3-D structures

17.11.2017 | Health and Medicine

The importance of biodiversity in forests could increase due to climate change

17.11.2017 | Studies and Analyses

VideoLinks
B2B-VideoLinks
More VideoLinks >>>