Percutaneous coronary intervention dual antiplatelet therapy compliance and stent thrombosis

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention: Coronary Stents[1] (DO NOT EDIT)

Class I
"1. Before implantation of drug eluting stent (DES), the interventional cardiologist should discuss with the patient the need for and duration of dual antiplatelet therapy (DAPT) and the ability of the patient to comply with and tolerate DAPT.[2] (Level of Evidence: C)"
"2. Drug eluting stent (DES) are useful as an alternative to BMS to reduce the risk of restenosis in cases in which the risk of restenosis is increased and the patient is likely to be able to tolerate and comply with prolonged dual antiplatelet therapy (DAPT). For elective PCI [3][4][5][6][7] (Level of Evidence: A); for UA/NSTEMI [5] (Level of Evidence: C); for STEMI [5][6][8][9][10] (Level of Evidence: A)."
"3. Balloon angioplasty or BMS should be used in patients with high bleeding risk, inability to comply with 12 months of dual antiplatelet therapy (DAPT), or anticipated invasive or surgical procedures within the next 12 months, during which time dual antiplatelet therapy (DAPT) may be interrupted.[11][12][13][14] (Level of Evidence: B)"
Class III (No Benefit)
"1. PCI with coronary stenting should not be performed if the patient is not likely to be able to tolerate and comply with dual antiplatelet therapy (DAPT).[11][15][16] (Level of Evidence: B)"
"2. Drug eluting stent (DES) should not be implanted if the patient is not likely to be able to tolerate and comply with prolonged dual antiplatelet therapy (DAPT) or this cannot be determined before stent implantation.[11][12][13][14] (Level of Evidence: B)"

References

  1. ↑ Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. ↑ Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM (2007). "Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation". JAMA : the Journal of the American Medical Association. 297 (2): 159–68. doi:10.1001/jama.297.2.joc60179. PMID 17148711. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  3. ↑ Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE (2003). "Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery". The New England Journal of Medicine. 349 (14): 1315–23. doi:10.1056/NEJMoa035071. PMID 14523139. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  4. ↑ Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME (2004). "One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV trial". Circulation. 109 (16): 1942–7. doi:10.1161/01.CIR.0000127110.49192.72. PMID 15078803. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 5.2 Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL (2008). "Drug-eluting or bare-metal stents for acute myocardial infarction". The New England Journal of Medicine. 359 (13): 1330–42. doi:10.1056/NEJMoa0801485. PMID 18815397. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Möckel M, Ochala A, Kellock A, Parise H, Mehran R (2009). "Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction". The New England Journal of Medicine. 360 (19): 1946–59. doi:10.1056/NEJMoa0810116. PMID 19420364. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  7. ↑ Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, Hausleiter J, Seyfarth M, Ott I, Ibrahim T, Fusaro M, Laugwitz KL, Massberg S, Neumann FJ, Richardt G, Schömig A, Kastrati A (2011). "Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial". Lancet. 378 (9796): 1071–8. doi:10.1016/S0140-6736(11)61255-5. PMID 21872918. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  8. ↑ Pan XH, Chen YX, Xiang MX, Xu G, Wang JA (2010). "A meta-analysis of randomized trials on clinical outcomes of paclitaxel-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction patients". Journal of Zhejiang University. Science. B. 11 (10): 754–61. doi:10.1631/jzus.B0900302. PMC 2950236. PMID 20872982. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  9. ↑ Hao PP, Chen YG, Wang XL, Zhang Y (2010). "Efficacy and safety of drug-eluting stents in patients with acute ST-segment-elevation myocardial infarction: a meta-analysis of randomized controlled trials". Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 37 (5): 516–24. PMC 2953216. PMID 20978561. |access-date= requires |url= (help)
  10. ↑ Suh HS, Song HJ, Choi JE, Jang EJ, Son HJ, Lee SM, Kim JS, Choi D (2011). "Drug-eluting stents versus bare-metal stents in acute myocardial infarction: A systematic review and meta-analysis". International Journal of Technology Assessment in Health Care. 27 (1): 11–22. doi:10.1017/S0266462310001340. PMID 21262083. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  11. ↑ 11.0 11.1 11.2 Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P (2007). "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians". Journal of the American College of Cardiology. 49 (6): 734–9. doi:10.1016/j.jacc.2007.01.003. PMID 17291948. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  12. ↑ 12.0 12.1 Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong MK, Kim JJ, Park SJ (2006). "Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up". The American Journal of Cardiology. 98 (3): 352–6. doi:10.1016/j.amjcard.2006.02.039. PMID 16860022. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  13. ↑ 13.0 13.1 Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ (2006). "Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry". Circulation. 113 (24): 2803–9. doi:10.1161/CIRCULATIONAHA.106.618066. PMID 16769908. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  14. ↑ 14.0 14.1 Nasser M, Kapeliovich M, Markiewicz W (2005). "Late thrombosis of sirolimus-eluting stents following noncardiac surgery". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 65 (4): 516–9. doi:10.1002/ccd.20391. PMID 15926177. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  15. ↑ Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, Giambartolomei A, Diver DJ, Lasorda DM, Williams DO, Pocock SJ, Kuntz RE (1998). "A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators". The New England Journal of Medicine. 339 (23): 1665–71. doi:10.1056/NEJM199812033392303. PMID 9834303. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  16. ↑ Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (2007). "Stent thrombosis in randomized clinical trials of drug-eluting stents". The New England Journal of Medicine. 356 (10): 1020–9. doi:10.1056/NEJMoa067731. PMID 17296821. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)

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