Value of Postconditioning after Heart Attack May Be Seen only on Long Term Followup

MedicalResearch.com Interview with:

JAY H. Traverse, MD, FACC, FAHA Director of Research, Minneapolis Heart Institute Foundation Associate Professor of Medicine, Cardiovascular Division University of Minnesota School of Medicine

Dr. Traverse

JAY H. Traverse, MD, FACC, FAHA
Director of Research
Minneapolis Heart Institute Foundation
Associate Professor of Medicine
Cardiovascular Division
University of Minnesota School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Reperfusion injury may contribute a significant amount to final infarct size in setting of ST-elevation myocardial infarction (STEMI).

Several studies from Europe and Asia have suggested that modifying reperfusion with an angioplasty balloon of an occluded artery called postconditioning can reduce infarct size. However, not all studies show a benefit.

We hypothesized that patient selection of STEMI patients could contribute to these inconsistent findings so we performed the first postconditioning study in the US sponsored by the NIH using the strictest enrollment criteria of any study to minimize factors that influence infarct size (ischemic time, collaterals, pre-infarction angina, TIMI 0 flow) designed to maximize the benefit of postconditioning to see if it can actually reduce infarct size.

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Heart Attacks Less Common in Women, But More Likely To Be Fatal

MedicalResearch.com Interview with:
Dr. Edina Cenko  MD, PhD first author  and
Dr. Raffaele Bugiardini M.D. FESC, FAHA,
Professor of Cardiovascular Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

MedicalResearch.com: What is the background for this study?

Response: Recent studies have identified younger women as “at-higher risk of mortality” after acute myocardial infarction. However, There are few studies looking at sex differences in mortality of patients with ST-Elevation Myocardial Infarction (STEMI). None of these studies have adjusted outcomes for treatment and delay to primary PCI, which may largely contribute to variations in clinical decision making and sex differences in outcomes. We used a large data set with fully risk and medications-adjusted models to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age in this excess of risk.

MedicalResearch.com: What are the main findings? 

Response: The different twist to this manuscript is to demonstrate that even when women have the same aggressive interventional and medical therapy as men, they die more than men and much more if women are younger , less than 60 years

MedicalResearch.com: What should readers take away from your report?

Response: Younger women are less likely to have a STEMI, but when they do so they show an excess of 30-day death than men, even in primary PCI treated patients. One strategy does not fit all in terms of women and men and mortality after STEMI. We need a more personalized approach to cardiovascular care. Behind sex disparities, sex is a biological variable in myocardial infarction. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The study supports the new NIH initiative requiring researchers to factor sex into the design, analysis, and reporting of studies. Severe adverse effects in women were not recognized by clinical trials as there was not a sufficient sample of women. Studying (balancing or randomizing) both sexes may inform appropriate medical care for women.  

MedicalResearch.com: Is there anything else you would like to add? 

Response: The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment. This holds true even in patients undergoing primary PCI. However, more studies are needed. Findings from men could not necessarily be applied to women. It is central considering the effects of sex as a biological variable at all stages and in any type of research on ischemic heart disease.

Any disclosures? Nothing to disclose 

Citations:

Cenko E, Yoon J, Kedev S, et al. Sex Differences in Outcomes After STEMIEffect Modification by Treatment Strategy and Age. JAMA Intern Med. Published online April 09, 2018. doi:10.1001/jamainternmed.2018.0514 

 

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Chewing Loading-Dose of Ticagrelor Enhanced Platelet Inhibition in Heart Attack Patients

MedicalResearch.com Interview with:

Elad Asher, M.D, M.H.A Interventional Cardiologist, Director Intensive Cardiac Care Unit Deputy Director Heart Institute Assuta Ashdod Medical Cent

Dr. Asher

Elad Asher, M.D, M.H.A
Interventional Cardiologist,
Director Intensive Cardiac Care Unit
Deputy Director Heart Institute
Assuta Ashdod Medical Center

MedicalResearch.com: What is the background for this study?

Response: Dual antiplatelet therapy represents the standard care for treating ST elevation myocardial infarction (STEMI) patients. Given the higher risk of peri-procedural thrombotic events in patients undergoing primary percutaneous coronary intervention (PPCI), there is a need to achieve inhibition of platelet aggregation (IPA) more promptly. Although chewing ticagrelor has been shown to be more efficient for IPA in stable coronary disease and in patients with acute coronary syndrome (ACS)/non-ST elevation myocardial infarction (NSETMI), there are no studies that have specifically assessed the efficacy and safety of chewing ticagrelor in STEMI patients. Therefore, the aim of our study was to investigate whether chewing ticagrelor (180mg) loading dose is associated with more favorable platelet inhibitory effects compared with the conventional way of swallowing whole tablets loading dose in STEMI patients undergoing PPCI.

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Anticoagulation With Bivalirudin vs Heparin for STEMI treated with PCI: Pros and Cons of Each

MedicalResearch.com Interview with:

Dr. Ion S. Jovin, MD, ScD Associate Professor of Medicine at Virginia Commonwealth University Pauley Heart Center Director of the Cardiac Catheterization Laboratories and Site Director of the VCU Interventional Cardiology Fellowship Program at  McGuire V.A. Medical Center Visiting Assistant Professor in the Department of Surgery/Cardiothoracic Surgery Yale University, New Haven, CT

Dr. Jovin


Dr. Ion S. Jovin, MD, ScD

Associate Professor of Medicine at Virginia Commonwealth University Pauley Heart Center
Director of the Cardiac Catheterization Laboratories and
Site Director of the VCU Interventional Cardiology Fellowship Program at
McGuire V.A. Medical Center
Visiting Assistant Professor in the Department of Surgery/Cardiothoracic Surgery
Yale University, New Haven, CT

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is still uncertainty regarding the best anticoagulant for patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) and especially PCI done via radial (as opposed to femoral) access. Our study compared outcomes of patients with STEMI treated with PCI done via radial access in the NCDR database who received one of the two main anticoagulants: bivalirudin and heparin. There is a large degree of variation in the use of the two anticoagulants in PCI and in primary PCI both within the United States but also in the world.

We did not find a statistically significant difference between the outcomes of the two groups of patients, but we also found that a significant number of patients in both the heparin and in the bivalirudin group were also treated with additional medicines that inhibit platelet activation (glycoprotein IIb/IIIa inhibitors).

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Elevated Kidney Biomarker Creatinine Predicts Worse Outcome in STEMI Heart Attack

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General, Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention. MedicalResearch.com: What should readers take away from your report? Response: Creatinine level is being checked in almost all patients who present with STEMI within few hours of presentation. Based on previous reports and our results, creatinine is a critical marker that correlate not only with mortality, but is also with morbidity during hospital stay. This marker should be used as a predictor of worse outcomes; thus, patients with higher creatinine levels should be provided higher attention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Based on our study limitations, I would encourage performing similar outcomes analysis in larger group, multi-center registries. I would also suggest extending outcomes to post-discharge status including quality of life besides cardiovascular compilcations. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Abstract presented at the 2017 National Kidney Foundation Spring Clinical Meeting https://www.kidney.org/spring-clinical The Impact of Admission Serum Creatinine on Major Adverse Clinical Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Dr. Khayata

Mohamed Khayata, MD
Internal Medicine Resident PGY-3
Cleveland Clinic Akron General
Akron, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors.

We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI.

Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention.

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Ischemic Postconditioning During Primary PCI for Patients With STEMI Heart Attack

MedicalResearch.com Interview with:

Thomas Engstrøm Senior Consultant dr. sci., MD, PhD The Heart Center | Rigshospitalet | University of Copenhagen | Denmark Professor in cardiology | University of Lund | Sweden Adjunct professor in cardiology | University of Aalborg | Denmark

Dr. Engstrøm

Thomas Engstrøm  MD, PhD
The Heart Center | Rigshospitalet | University of Copenhagen | Denmark
Professor in cardiology | University of Lund | Sweden
Adjunct professor in cardiology | University of Aalborg | Denmark 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Timely reperfusion by primary angioplasty (primary PCI) in patients with ST-elevation myocardial infarction is mandatory. However reperfusion it self can harm the myocardium – so called reperfusion injury. During a number of years ischemic postconditioning (iPOST) by repetitive interruptions of blood flow after reperfusion has been a promising technique to address reperfusion damage.

The trial investigated the effect of iPOST in 1200 patients treated with primary PCI and in addition either iPOST or conventional angioplasty.

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