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Lo mejor en cardiopatía
isquémica e intervencionismo
#postACC16
Dr. Marcelo Sanmartín Fernández
Hospital Universitario Ram...
The Third DANish Study of Optimal Acute Treatment of Patients with
ST-segment Elevation Myocardial Infarction: DEFERred st...
TIMI 0-I TIMI 2-3
Postcon
TIMI 0-I
PCI
TIMI 2-3
DeferConv
STEMI
Angiography
Excluded
Flow Chart DANAMI-3
PCI
Randomization
Methods
DEFER:
• Minimal acute manipulation to restore stable flow in IRA
• Stent implantation 48 hours later
Conventional...
Median stent diameter (mm) 3∙5 3∙5
Median stent length (mm) 22 18 *
No stenting 3% 15%*
Use of GP-inhibitor or Bivalirudin...
0.000.050.100.150.200.25
Eventrate
603 543 526 359 156 0Deferred
612 568 533 360 159 0Conventional
Number at risk
0 1 2 3 ...
0.000.050.100.150.200.25
Eventrate
603 584 575 409 180 0Deferred
612 594 575 403 173 0Conventional
Number at risk
0 1 2 3 ...
Left ventricular ejection fraction (LVEF)
at 18 months
Conventio
nal
DEFER P
Median LVEF 57% 60% 0∙04
No of patients with
...
Conclusion I
Deferred stent implantation in patients with STEMI
did not reduce the risk of death, heart failure, or
reinfa...
Conventional
treatment
coronary artery
ReperfusionOccluded
Reperfusion
injury
Reperfusion
injuryIschemic
postconditioning
...
Outcome
Convention
al
(n = 617)
iPOST
(n = 617)
Hazard ratio
[95% CI]
p
Primary composite
endpoint
69 (11∙2) 65 (10∙5) 0·9...
Conventional
(n = 299)
iPOST
(n = 275)
P
LVEF all patients (%) 50.8 52.7 <0.05
LVEF anterior infarcts (%) 45.9 49.5 0.04
N...
(Código IM Madrid)
Safety and Efficacy of CMX-2043 for Periprocedural Injury Protection in Subjects
Undergoing Coronary Angiography at Risk o...
SURVIVAL TO HOSPITAL DISCHARGE
RANDOMIZE
(open study kit)
Neither
Saline Placebo
(N=1059)
Amiodarone
(n=974)
Lidocaine
(n=...
The Amiodarone, Lidocaine or Placebo Study
(ALPS)
• Primary outcome, survival to hospital discharge, for amiodarone vs.
li...
Efficacy and safety of ticagrelor in patients
with prior MI and MVD: PEGASUS-TIMI 54
SWAP-3
DAPT score
Yeh RW, JAMA 29 marzo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
Lo mejor en cardiopatía isquémica e intervencionismo
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Lo mejor en cardiopatía isquémica e intervencionismo

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Lo mejor del Congreso ACC Chicago 2016
06/04/16 14:00 - 15:30h Casa del Corazón, Madrid
http://acc16.secardiologia.es

Lo mejor en cardiopatía isquémica e intervencionismo
Dr. Marcelo Sanmartín Fernández, Hospital Universitario Ramón y Cajal, Madrid
@ImMSanFer

Publicado en: Salud y medicina
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Lo mejor en cardiopatía isquémica e intervencionismo

  1. 1. Lo mejor en cardiopatía isquémica e intervencionismo #postACC16 Dr. Marcelo Sanmartín Fernández Hospital Universitario Ramón y Cajal (Madrid) @ImMSanFer
  2. 2. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: DEFERred stent implantation in connection with primary PCI: DANAMI 3-DEFER
  3. 3. TIMI 0-I TIMI 2-3 Postcon TIMI 0-I PCI TIMI 2-3 DeferConv STEMI Angiography Excluded Flow Chart DANAMI-3 PCI Randomization
  4. 4. Methods DEFER: • Minimal acute manipulation to restore stable flow in IRA • Stent implantation 48 hours later Conventional PCI: • Immediate stent implantation Aim of DANAMI-3-DEFER study To evaluate whether the prognosis of STEMI patients treated with pPCI can be improved by deferred stent implantation
  5. 5. Median stent diameter (mm) 3∙5 3∙5 Median stent length (mm) 22 18 * No stenting 3% 15%* Use of GP-inhibitor or Bivalirudin 92% 93% Thrombus aspiration 58% 63% TIMI flow before PCI** 0 - 1 2 - 3 38% 62% 38% 62% TIMI flow after PCI** 0 - 1 2 - 3 1∙0% 99% 1.0% 99% Procedural data * P < 0.001 ** self-reported Conventional (n = 612) DEFER (n = 603)
  6. 6. 0.000.050.100.150.200.25 Eventrate 603 543 526 359 156 0Deferred 612 568 533 360 159 0Conventional Number at risk 0 1 2 3 4 5 Time (years) Conventional Deferred HR: 0.99 [0.75-1.29]; P=0.92 Primary endpointPrimary endpoint
  7. 7. 0.000.050.100.150.200.25 Eventrate 603 584 575 409 180 0Deferred 612 594 575 403 173 0Conventional Number at risk 0 1 2 3 4 5 Time (years) Conventional Deferred A HR: 0.83 [0.56 - 1.24]; P=0.37 All cause mortality 0.000.050.100.150.200.25 Cumulativeincidence 603 576 563 395 172 0Deferred 612 580 560 391 167 0Conventional Number at risk 0 1 2 3 4 5 Time (years) Conventional Deferred C HR: 0.82 [0.47 - 1.43]; P=0.49 Hospitalisation for heart failure 0.000.050.100.150.200.25 Cumulativeincidence 603 564 550 383 167 0Deferred 612 586 554 379 165 0Conventional Number at risk 0 1 2 3 4 5 Time (years) Conventional Deferred B HR: 1.1 [0.69 - 1.64]; P=0.77 Recurrent myocardial reinfarction 0.000.050.100.150.200.25 Cumulativeincidence 603 559 549 382 167 0Deferred 612 587 561 387 170 0Conventional Number at risk 0 1 2 3 4 5 Time (years) Conventional Deferred D HR: 1.7 [1.04 - 2.92]; P=0.03 Unplanned target vessel revascularisation Components of the primary endpoint
  8. 8. Left ventricular ejection fraction (LVEF) at 18 months Conventio nal DEFER P Median LVEF 57% 60% 0∙04 No of patients with LVEF ≤45% 18% 13% 0∙05 Secondary endpoint
  9. 9. Conclusion I Deferred stent implantation in patients with STEMI did not reduce the risk of death, heart failure, or reinfarction compared with standard immediate stent implantation
  10. 10. Conventional treatment coronary artery ReperfusionOccluded Reperfusion injury Reperfusion injuryIschemic postconditioning 30 30 30 sec3030 30 30 30 Balloon inflations – deflations Ischemic postconditioning DANAMI3-iPOST
  11. 11. Outcome Convention al (n = 617) iPOST (n = 617) Hazard ratio [95% CI] p Primary composite endpoint 69 (11∙2) 65 (10∙5) 0·93 [0∙66 – 1∙30] 0∙66 All-cause mortality 50 (8∙1) 38 (6∙2) 0∙75 [0∙49 – 1∙14] 0∙18 Heart failure hospitalization 30 (4∙9) 30 (4∙9) 0∙99 [0∙60 – 1∙64] 0∙96 Cardiovascular mortality 30 (4∙9) 26 (4∙2) 0∙86 [0∙51 – 1∙45] 0∙56 Recurrent myocardial infarction 29 (4∙7) 33 (5∙4) 1∙13 [0∙68 – 1∙86] 0∙64 TVR by PCI 14 (2∙3) 19 (3∙1) 1∙35 [0∙67 – 2∙68] 0∙40 TVR by CABG 2 (0∙3) 6 (1∙0) 2∙97 [0∙60 – 14∙72] 0∙28 DANAMI3-iPOST outcomes DANAMI3-iPOST
  12. 12. Conventional (n = 299) iPOST (n = 275) P LVEF all patients (%) 50.8 52.7 <0.05 LVEF anterior infarcts (%) 45.9 49.5 0.04 Number of patients with LVEF >45% 215 (72%) 220 (80%) 0.015 DANAMI3-iPOST DANAMI3-iPOST outcomes
  13. 13. (Código IM Madrid)
  14. 14. Safety and Efficacy of CMX-2043 for Periprocedural Injury Protection in Subjects Undergoing Coronary Angiography at Risk of Radio-contrast Induced Nephropathy - CARIN • Objetivo: demostrar seguridad y eficacia del CMX-2043 en prevenir empeoramiento función renal tras ICP • Diseño: Inclusión: - FGE 15 a 45 ml/min o 45-60 ml/min + uno de los siguientes: edad >75 años, diabetes, FEVI<40%, Hipotensión, ICC. Aleatorización 1:1:1:1 a CMX-2043 2.4 mg/kg (n = 87), 3.6 mg/kg (n = 94), 4.8 mg/kg (n = 87), o placebo (n = 93). • Endpoint primario -AKI a 4 días (> creat 0,3 mg/dl), para CMX-2043 2.4 mg/kg vs 3.6 mg/kg vs 4.8 mg/kg vs. placebo: 25.6% vs. 25.3% vs. 18.9% vs. 18.6%, p > 0.05 • Conclusiones: el fármaco no es más eficaz que el placebo, no hubo otras diferencias en complicaciones periprocedimiento.
  15. 15. SURVIVAL TO HOSPITAL DISCHARGE RANDOMIZE (open study kit) Neither Saline Placebo (N=1059) Amiodarone (n=974) Lidocaine (n=993) Vascular Access Adult nontraumatic out-of-hospital cardiac arrest Persistent or recurrent VF/VT after ≥ 1 shock(s)    Vasopressor Hospital Admission - Monitored Care The Amiodarone, Lidocaine or Placebo Study (ALPS)
  16. 16. The Amiodarone, Lidocaine or Placebo Study (ALPS) • Primary outcome, survival to hospital discharge, for amiodarone vs. lidocaine vs. placebo: 24.4% vs. 23.7% vs. 21.0% (amiodarone vs. placebo, p = 0.08; lidocaine vs. placebo, p = 0.16) • Secondary outcomes (for amiodarone vs. lidocaine vs. placebo): – Survival with favorable neurological status: 18.8% vs. 17.5% vs. 16.6%, p = 0.19 and 0.59, respectively vs. placebo) – Return of spontaneous circulation at emergency department arrival: 35.9% vs. 39.9% vs. 34.6% – Number of EMS shocks: 5 vs. 5 vs. 6, p < 0.0001 – Clinical seizure activity within 24 hours: 3.2% vs. 5.1% vs. 3.7%, p = 0.07 – Temporary cardiac pacing within 24 hours: 4.9% vs. 3.2% vs. 2.7%, p = 0.02
  17. 17. Efficacy and safety of ticagrelor in patients with prior MI and MVD: PEGASUS-TIMI 54
  18. 18. SWAP-3
  19. 19. DAPT score Yeh RW, JAMA 29 marzo

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