Post-percutaneous Coronary Intervention Patients Research Articles

Meta-analysis of studies examining the external validity of the dual antiplatelet therapy score.

The dual antiplatelet therapy (DAPT) score is meant to aid clinicians choose the DAPT duration but attempts to examine the external validity of the DAPT score and its decision tool have reported mostly disappointing results. Our aim was to perform a meta-analysis of all available data on the external validity of the DAPT score. We conducted a meta-analysis of studies that examined the external validity of the DAPT score/its decision tool. Seven studies (77274 patients) were included. Follow-up ranged from 6 to 24 (median 18) months. Overall, high (≥2) DAPT score was associated with increased risk for myocardial infarction (MI)/stent thrombosis (ST) [odds ratio (OR) 1.54, 95% confidence interval (CI) 1.41-1.69; P < 0.01], and lower risk for bleeding (OR 0.84, 95% CI 0.73-0.97; P = 0.01). In the high DAPT score stratum, extended (12-24 months), as compared to standard (6-12 months) DAPT duration was associated with a reduction in the risk for MI/ST (OR 0.67, 95% CI 0.48-0.94; P = 0.02), and no difference in the risk for bleeding (OR 1.04, 95% CI 0.65-1.66; P = 0.88), while in the low DAPT score stratum, extended DAPT duration was associated with no difference in the risk for MI/ST (OR 1.04, 95% CI 0.76-1.43; P = 0.80), and an increased risk for bleeding (OR 1.58, 95% CI 1.15-2.15; P < 0.01). This first meta-analysis of studies examining the external validation of the DAPT score and its decision tool, our results suggest that the DAPT score is useful both for stratifying post-percutaneous coronary intervention patients into risk strata for future ischaemic and bleeding events as well aiding in choosing the optimal DAPT duration for the individual patient.

Prevalence and association of medication nonadherence with major adverse cardiovascular events in patients with myocardial infarction.

Current study was to evaluate the prevalence of guideline recommended medications adherence in myocardial infarction (MI) patients postpercutaneous coronary intervention (PCI) and the association of medication nonadherence and major adverse cardiovascular events (MACEs).MI patients who underwent PCI in the last 12 months were enrolled. Demographic and clinical characteristics were collected and guideline recommended medications were evaluated. Patients were divided into with and without MACEs groups.Compared to patients without MACEs, those with MACEs were older (54.8 ± 16.4 vs 51.1 ± 15.2 years), more likely to be smoker (40.2% vs 31.9%), have higher body mass index (BMI; 25.0 ± 6.1 vs 23.8 ± 5.7 kg/m2), diabetes (47.5% vs 37.8%), ischemic stroke (34.4% vs 25.6%), and estimated lower glomerular filtration rate (85.4 ± 9.6 vs 92.6 ± 10.7 mL/minute/1.73 m2). Patients with MACEs were also more likely to present with ST-elevation MI (STEMI; 54.1% vs 48.4%) and to undergo urgent PCI (62.3% vs 56.3%). Furthermore, patients with MACEs were less likely to adhere to dual antiplatelet therapy (77.9% vs 85.9%), renin−angiotensin system inhibitor (62.3% vs 69.7%), and beta-blocker (69.7% vs 72.8%) treatment. In unadjusted model, medication nonadherence was associated with 2-fold higher odds of MACEs. After adjustment for demographics, risk factors, comorbidities, and peri-PCI characteristics, medications nonadherence remained independently associated with MACEs, with odds ratio of 1.40 (95% confidence interval: 1.29–1.87).Medications adherence rate among MI patients post-PCI is suboptimal in China, which is independently associated with MACEs.

Outcomes of nurse-led clinic for patients treated with percutaneous coronary intervention: A retrospective analysis

BackgroundWith an increasing prevalence of coronary heart disease, secondary prevention forms a major cornerstone of management. A dedicated nurse-led clinic for patients post percutaneous coronary intervention (PCI) offers a great opportunity to address risk factors in order to reduce cardiovascular events. PurposeTo determine the impact of a nurse-led clinic follow up of patients post PCI in relation to the 30 day mortality rate and re-admission, and patient satisfaction. Risk factor assessment, compliance with dual antiplatelet therapy (DAPT), and interventions at the clinic visit were also assessed. MethodsA retrospective review of parameters recorded at clinic appointments from January 2015–December 2017. The data of patients were examined for baseline characteristics, risk factor assessment, and interventions at the clinic visit. Thirty day mortality and re-admission rates and patient satisfaction were major outcomes. Results1325 individual patient records were retrospectively reviewed in our clinic. Mean age was 64 and 78% were males. The indications for PCI were STEMI (22.7%), NSTEMI (21.9%), and unstable and stable angina (43.1%). 5 patients (0.4%) died and 132 patients (10%) were re-admitted within 30 days after the follow-up visit. However, only 24 (1.8%) of the re-admissions were due to cardiac reasons. At the clinic appointment, 852 (64.3%) patients had non-pharmacological intervention and 473 (35.7%) patients had a pharmacological intervention. 712 (53.7%) patients had LDL-C above target and their statin therapy was amended accordingly. ConclusionNurse-led PCI clinics provide satisfactory assessment and management of risk factors achieving high patient satisfaction rates without increased risk of poor outcomes.

Descriptive analysis of real-world medication use pattern of statins and antiplatelet agents among patients with acute coronary syndrome in Hong Kong and the USA

ObjectivesThe objective was to explore the differences in medication use pattern of lipid-lowering drug (LLD) and antiplatelet agents among post-percutaneous coronary intervention patients with acute coronary syndrome aged <65 in...

Pengaruh Kompres Dingin dalam Penurunan Nyeri Pasien Post Percutaneous Coronary Intervention (PCI): Literature review

Introduction: Complications in catheterization vascular access range from 1%-61%. One of interventions that can be taken to prevent hematoma and reduce pain in post PCI patients at off sheath is with cold compresses or ice bag. The fact shows that pain and hematoma in patient PCI in hospital just done by using sand bag therapy. There was a limited review about the use of ice bag to reduce pain in patients with PCI.Methods: Searched articles through Science Direct, PubMed, EBSCO and Google Scholar conducted using advanced searching with keywords including “ice bag”, “pain”, and “percutaneous coronary intervention”. Searching through Google Scholar using keywords involving “effectiveness of ice bag on pain in patient’s percutaneous coronary intervention (PCI)”.Results: There were three articles control trials and the results showed that implementation of cold compresses with ice bag for 20 minutes before and after catheter release in PCI measures was significant in reducing pain (P &lt;0.05).Conclusion: Giving cold compresses can reduce pain because it can inhibit the fibber of small-diameter nerves in delivering pain stimuli.

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

To evaluate the effectiveness and safety of oral Chinese herbal medicines (CHMs) on post-percutaneous coronary intervention (PCI) patients with depressive disorder in coronary heart disease (CHD). A literature search was conducted through databases including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2018. Randomized controlled trials (RCTs) comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 software was used to synthesize the results. A total of 16 RCTs enrolling 1,443 participants were included in this systematic review. When compared with antidepressants alone, CHMs showed similar benefits with less side effects [risk ratio=0.54, 95% confidence interval (CI) 0.43 to 0.69, 582 patients]; meanwhile, the combination therapy may have more advantages than antidepressants alone [mean difference (MD)=-1.03, 95%CI-1.81 to-0.25, 267 patients). When identified with placebo, CHMs seem to have more advantages in relieving depressive symptoms (MD=-19.00, 95%CI-20.02 to-17.98, 189 patients). However, when compared with basic treatment of post- PCI, CHMs showed different results in two trials. In terms of post-PCI related clinical symptoms, CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms. However, the heterogeneity in this review was generally high, it may be caused by different interventions used in each trial and the low quality of the trials. In total, CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.

Application of cardiac rehabilitation program based Omaha system in post percutaneous coronary intervention patients

Objective To investigate the effect of the cardiac rehabilitation program based Omaha system on patients after percutaneous coronary intervention (PCI) . Methods A convenient sampling method was used to select 127 patients from the Department of Cardiology of Wuxi Second People's Hospital from October 2017 to April 2018. According to the patient's hospitalization number, they were randomly divided into two groups, including 64 in the experimental group and 63 in the control group. During the intervention, 2 patients were lost in the experimental group and 1 patient was lost in the control group. There were 62 patients in each group to complete the study. Patients in the control group received routine care, while patients in the experimental group received cardiac rehabilitation based on the Omaha system. The effect of the intervention was measured by 6 min exercise test, secondary prevention knowledge and behavior questionnaire for post-PCI patients. Results After the intervention, The 6-minute exercise distance was (439.28±67.94) m in the experimental group, and it was (315.62±45.18) m in the control group. The exercise endurance of the experimental group was higher than that of the control group, and the difference was statistically significant (t=11.934, P<0.01) . The secondary prevention knowledge and behavior scores of the experimental group were (87.21±12.46) and (84.27±14.58) , which were higher than those of the control group (71.30±8.12) and (65.94±8.97) . The differences were statistically significant (t=8.423, 8.431; P <0.01) . Conclusions Cardiac rehabilitation programs based Omaha system can improve exercise endurance and secondary prevention behaviors of patients after PCI and its application should be promoted. Key words: Heart; Rehabilitation; Omaha system; Percutaneous coronary intervention; Exercise endurance; Secondary prevention

Reducing the Incidence of Back Pain in Post-Percutaneous Coronary Intervention Patients With Femoral Sheath

Patients undergoing percutaneous coronary interventions (PCIs) are restricted to bedrest and immobilization of the affected leg for sheath retention. These result in high incidences of back pain and emotional irritation, which may negatively affect cardiac rehabilitation. One-hundred percent of the post-transfemoral PCI patients in our unit had a back-pain score of 3 or higher, with an average pain score of 6. Analysis showed the main causes to be: poor awareness of nurses regarding back pain and physical activity; lack of physical activity guidelines and no regular auditing of physical activity; and lack of education and related materials. To increase the completion rate of instruction for physical activity to over 90.0% and to reduce the incidence of back pain (score of 3 or higher) among post-PCIs to 35.0% or less. We conducted in-service education, revised related instruction materials, filmed the recommended physical activity for post-PCIs, and conducted a quality assurance audit. The completion rate among post-PCIs for the instructions for physical activity increased from 32.5% to 90.0%. The incidence of back pain (score >3) reduced from 100% to 26.8%. Implementing a physical activity education program with multimedia materials and regular audits effectively reduces the discomfort of patients following PCIs.

Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging in the assessment of the dynamic status of myocardial perfusion.

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide and places a significant financial burden on our society. To determine the feasibility of cardiac intravoxel incoherent motion (IVIM) in the consecutive evaluation of myocardial perfusion in myocardial infarction patients postpercutaneous coronary intervention (PCI) and to investigate the dynamic biological phenomena in myocardial perfusion after AMI. Prospective observational study. Twenty ST-segment elevation myocardial infarction (STEMI) patients after reperfusion therapy and 12 healthy volunteers served as controls. Cardiac MRI at 3T, including steady-state free precession (SSFP) cine imaging, T2 -short time inversion recovery (T2 -STIR), late gadolinium enhancement (LGE), T2 mapping, and IVIM diffusion-weighted imaging (DWI) were performed. Myocardial T2 value and IVIM-DWI-associated parameters (ADCfast , ADCslow , and f value) of the infarcted myocardium at different timepoints, remote myocardium, and normal myocardium were analyzed by two experienced radiologists. Independent sample's t-test, Pearson's, and Spearman's correlation and interobserver variability were applied. P ≤ 0.05 was considered significant. The T2 value in ischemic myocardium measured on day 3 (73.58 ± 4.37 msec) was greater than at any other timepoint (24 hours, day 7, day 30; 66.66 ± 4.71 msec, 68.36 ± 4.18 msec, 64.98 ± 5.39 msec, respectively, P < 0.001). ADCfast and f values were significantly lower in ischemic myocardium than in the remote myocardium as well. The f value in ischemic myocardium at day 3 (0.0989 ± 0.02) was lower than at any other timepoint (24 hours, 7 day, 30 day; 0.1203 ± 0.02, 0.1109 ± 0.02, 0.1213 ± 0.02, respectively, P < 0.001. This preliminary study demonstrated that a dynamic process exists in the status of myocardial edema and myocardial perfusion in MI patients after PCI. The findings suggest myocardial perfusion would be best evaluated between day 3 and day 7. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1602-1609.

Gender differences in home-based cardiac rehabilitation of post-percutaneous coronary intervention patients.

Cardiac rehabilitation (CR) is a structured program for the prevention of secondary cardiovascular disease (CVD) and related diseases, such as hypertension, diabetes, and obesity. This study aimed to investigate whether there are gender differences after 9months of home-based cardiac rehabilitation program in post-percutaneous coronary intervention patients. A total of 114 (58.29 ± 10.33years) men and 30 (60.90 ± 9.32years) women were enrolled in the CR program. The program included three visits: initial, 4th month (follow-up), and 9th month (final) visits at a CR center. The CR program included exercise and nutrition counseling. In nutrition counseling, a professional nutritionist educated the patients on how to organize the menu, incorporating an optimal caloric, low-salt, and low-cholesterol diet. Exercise was performed 30min per session for more than 3days per week with a target heart rate within 40-75% of the peak heart rate-resting heart rate (VO2 reserve; VO2R) during intense exercise, which was based on ECG treadmill test. After 9 months, there was no significant difference in terms of dropout rate between men and women (p < 0.05). No significant changes were found in the anthropometric and lipid profiles in women, whereas the HDL-cholesterol (HDL-C) was significantly increased to 6.8% (p = 0.005) in men. The findings of our study showed that there was no difference in the CR participation rate between men and women. Moreover, there was an increase in HDL-C levels and an improvement in cardiorespiratory endurance, strength, and agility in men, whereas no significant difference in most risk factors and fitness variables was found in women. Thus, the 9-month home-based CR program was more effective for fitness in men, but only the HDL-C showed positive improvement among the cardiovascular risk factors. In women, 6-min walk and timed up and go were effective exercises.

An Observational Study: Ambulatory Blood Pressure Monitoring after Percutaneous Transluminal Coronary Angioplasty

Abstract Aim In recent studies, lack of fall in nocturnal blood pressure (BP) has been presented as an independent predictor of poor prognosis. The aim of this study is to investigate the prognostic value of various variables of BP by 24-hour ambulatory blood pressure (ABP) measurement and sex-related differences after percutaneous transluminal coronary angioplasty (PTCA). Methods This study included 100 patients who underwent PTCA in the authors’ institute from June 2017 to January 2018. They were monitored by 24-hour ABP for 1 day in the hospital. Results One hundred patients were recruited in this study with mean age of 61.64 years, with female-to-male ratio of 0.27:1. All demographic, clinical, and laboratory parameters including the ABP parameters were comparable between females and males, except smoking and alcoholism that were more frequent in males.Out of 100 patients, 41 had nocturnal dipping in BP and 59 did not have nocturnal dipping. In this study, the variables among nondippers, 16 (27.1%) were females, 43 (72.8%) were males, 45 (63.3%) had diabetes mellitus (DM), 46 (75.4%) had hypertension (HTN), mean systolic blood pressure (SBP) was 141.7 ± 13.9 mm Hg, mean diastolic blood pressure (DBP) was 86.34 ± 5.64 mm Hg, mean pulse pressure (PP) was 55.39 ± 9.25 mm Hg, and pulse-wave velocity (PWV) was 6.69 ± 2.22 m/s.In females were more nondippers (27.1%) than dippers (12.1%), which was statistically significant (p = 0.05). Nondippers were more among hypertensive patients (77.9% vs. 36.5%; p = 0.00). Higher mean SBP (p = 0.001), higher mean BP (p = 0.032), and higher mean pulse pressure (p = 0.00) were observed in nondippers.However, age, ejection fraction (EF), presence of DM, coronary artery disease (CAD) severity, type of presentation, and PWV were not different in dipper versus nondippers. Conclusion With comparable clinical, laboratory parameters along with BP parameters between females and males, immediate post-percutaneous coronary intervention (PCI) patients, female PCI patients had more nondippers (p = 0.05). Overall nondippers had higher SBP, mean BP, and PP than dippers. Diabetes, severity of CAD, and type of presentation of CAD (as ACS or CSA) did not influence the nocturnal dipping quality of the BP.

Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention.

To identify the predictors of adherence in patients with coronary heart disease after a percutaneous coronary intervention. Adherence is a key factor in preventing the progression of coronary heart disease. An analytical multihospital survey study. A survey of 416 postpercutaneous coronary intervention patients was conducted in 2013, using the Adherence of People with Chronic Disease Instrument. The instrument consists of 37 items measuring adherence and 18 items comprising sociodemographic, health behavioural and disease-specific factors. Adherence consisted of two mean sum variables: adherence to medication and a healthy lifestyle. Based on earlier studies, nine mean sum variables known to explain adherence were responsibility, cooperation, support from next of kin, sense of normality, motivation, results of care, support from nurses and physicians, and fear of complications. Frequencies and percentages were used to describe the data, cross-tabulation to find statistically significant background variables and multivariate logistic regression to confirm standardised predictors of adherence. Patients reported good adherence. However, there was inconsistency between adherence to a healthy lifestyle and health behaviours. Gender, close personal relationship, length of education, physical activity, vegetable and alcohol consumption, LDL cholesterol and duration of coronary heart disease without previous percutaneous coronary intervention were predictors of adherence. The predictive factors known to explain adherence to treatment were male gender, close personal relationship, longer education, lower LDL cholesterol and longer duration of coronary heart disease without previous percutaneous coronary intervention. Because a healthy lifestyle predicted factors known to explain adherence, these issues should be emphasised particularly for female patients not in a close personal relationship, with low education and a shorter coronary heart disease duration with previous coronary intervention.

Risk Factors Associated with Acute Coronary Syndrome after Successful Percutaneous Coronary Intervention

Abstract Objective: Admission for acute coronary syndrome after successful percutaneous coronary intervention is a delicate situation for the patient and doctor. Predictors of these cases are poorly described. Methods: We retrospectively analysed the files of post-percutaneous coronary intervention patients admitted to the Department of Cardiology of the Institute for Cardiovascular Disease and Heart Transplant in Tirgu Mures between January 2012 and December 2015. Analyses using the t-test, chi-square test, and Fisher test were performed to compare demographics, clinical and angiographic characteristics of patients with acute coronary syndrome, patients with stable angina, and those without symptoms. Results: One hundred eighty post-percutaneous coronary intervention patients were readmitted; 46 patients (25.55%) were readmitted for acute coronary syndrome. Histories of arterial hypertension and renal dysfunction at hospital admission were associated with acute coronary syndrome. Bare metal stent in-stent restenosis and localisation of bare metal stent in-stent restenosis of the left descendent coronary artery were angiographic predictors of acute coronary syndrome. Conclusion: Several clinical and angiographic factors identify patients at high risk for acute coronary syndrome after successful percutaneous coronary intervention. Recognition and treatment of these factors may prevent readmission for such a dangerous condition and may improve outcomes.

Patterns of statin non-prescription in patients with established coronary artery disease: A report from a contemporary multicenter Japanese PCI registry

Statin therapy is regarded as an effective medication to reduce cardiovascular events in patients at higher risk for future incidence of coronary artery disease. However, very few studies have been conducted to examine its implementation in non-Western real-world practice. In this study, we sought to describe statin prescription patterns in relation to patient characteristics in a Japanese multicenter percutaneous coronary intervention (PCI) registry as a foundation for quality improvement. We studied 15,024 patients that were prospectively enrolled in the Japan Cardiovascular Database-Keio interhospital Cardiovascular Study Registry from January 2009 to August 2014. The overall discharge statin non-prescription rate was 15.2%, without significant interhospital (MOR = 1.01) or annual differences (MOR = 1.13) observed. Hierarchical multivariable logistic regression analysis accounting for regional differences revealed that the presence of chronic kidney disease was associated with higher rates of statin non-prescription (OR 1.87, 95% confidence interval, 1.69–2.08, p value <0.001), and higher age (per 1-year increase) showed a trend for prescription of low-intensity statin (OR 1.00, 95% confidence interval, 1.00–1.01, p value = 0.045) within the subset of PCI patients (N = 4,853) enrolled after the year 2011. Our study indicates that patients with chronic kidney disease and elderlies may be the primary targets for maximizing the beneficial effect of statin therapy in post PCI patients.

Modifikasi Miring Kiri dan Elevasi Kepala Menurunkan Back Pain Post Percutaneous Coronary Intervention

Introduction: Modified left lateral position and head elevation is a very important for 6 hours patient immobility after percutaneous coronary intervention. Patient immobility have higher risk of discomfort or back pain and leg pain. The objective of this study was to identify the effect of modified left lateral position and head elevation on pain reduction after percutaneous coronary intervention (PCI) with vascular closure device. Method: A quasy experimental design was used in this study with population were percutaneous coronary intervention (PCI) patient in Surabaya International Hospital. There were 20 respondents who met to the inclusion criteria which taken by using purposive sampling technique and divided into two groups, 10 respondents as experiment group and 10 respondents as control group. Data were collected by using questionnaire and observation for pain respons and distal pulsation (dorsalis pedis artery), then data were analyzed by using Mann Whitney U test and Independent t-Test with significance level a=0.01. Result: The results showed that there was a significance effect of modified left lateral position and head elevation on reducing back pain with Mann Whitney U test (p=0.00) and there was a significance effect of modified left lateral position and head elevation on the change of dorsalis pedis pulsation with Independent t-Test (p=0.00). Discussion: It can be concluded that modified left lateral position and head elevation reduce back pain on patients post percutaneous coronary intervention. Further studies should be developed to identify the effect of modified left lateral position and head elevation on other variables of pain and stress.

PP-178 [AJC » Preventive cardiology] Effect of Phase 2 Cardiac Rehabilitation Program on High-Sensitivity C-Reactive Protein Levels in Post-Percutaneous Coronary Intervention Patients

PP-178 [AJC » Preventive cardiology] Effect of Phase 2 Cardiac Rehabilitation Program on High-Sensitivity C-Reactive Protein Levels in Post-Percutaneous Coronary Intervention Patients

Post-Percutaneous Coronary Intervention Patients’ Perceptions and Management of Femoral Arterial Access Sites After Attending a Nurse-Led Clinic: A Pilot Study

Background: After undergoing a percutaneous coronary intervention (PCI), patients are discharged home and expected to self-manage all aspects of their post-discharge care, while awaiting cardiology review. This wait-time can be stressful for both first and repeat revascularisation patients in light of potential post-discharge complications which may be experienced. Patients may also have health misconceptions regarding their access site and management. Aim: To explore patients’ perceptions and management of arterial access sites post- nurse-led clinic attendance. Methods: Participants were part of a randomised controlled clinical trial. Intervention group participants received face-to-face nurse-led education and support. Standard care participants received follow-up telephone calls. As a duty of care the researcher engaged with some standard care group participants. Follow-up occurred at four time-points. Data were collected via participant self-report. Participants in both groups discussed their access sites and provided images to reflect their perception of healing at each time-point. Results: Overall, for all participants, minor vascular complications occurred post-procedurally and included bruising and small haematomas. Descriptions of participants’ access sites and healing were accurately reflected by photographic and/or diagrammatic images provided. All participants reported engaging in regular wound-site observation. Repeat revascularisation patients highlighted paying greater attention to their wound site than on previous occasions given the study's requirements to provide access site images. Conclusion: Overall, nurse-led follow-up demonstrated that regular contact and reinforcement of patient education facilitated greater access site observation and confidence to self-manage. Despite intervention group participants receiving additional education, all participants, based on having nurse contact reported better site care.

Genetic Polymorphisms of ABCB1 Gene in Patients Having Resistance to Clopidogrel

Objectives: We sought to study the genetic polymorphisms of ABCB1 gene in post percutaneous coronary intervention (PCI) patients with clopidogrel resistance. Background: Dual antiplatelet therapy (DAPT) is a guideline mandated therapy for patients who undergo PCI. However there exists interindividual variability in drug response to the antiplatelet agents leading to recurrent thrombotic events. Genetic polymorphisms of ABCB1 gene are one among the causes of this interindividual variability. Methods: It is a single center prospective trial and includes221 patients who underwent PCI and were given clopidogrel as a part of DAPT. Platelet reactivity was assessed by grading of platelet activity index (PAI) and considered as high on treatment platelet reactivity (HTPR), i.e., clopidogrel resistance if PAI > 5. Genetic analysis for ABCB1 C-T polymorphism was done by polymerase chain reaction (PCR) and single strand confirmation polymorphism (SSCP) analysis. Results: Amongst 221 patients, 37 (16.7%) patients had ABCB1 C-T polymorphisms. The mean PAI value in these patients was 5.1 ± 3.0, while it was 3.5 ± 2.5 in those patients without ABCB1 C-T polymorphisms (p = 0.004). Compared to patients without HTPR, the occurrence of primary endpoints was not significantly increased in patients with HTPR except for stent thrombosis which was significantly high in patients with HTPR. HTPR was also associated with ABCB1 C-T polymorphisms (p = 0.04), but these polymorphisms did not predict the clinical outcome. Conclusions: There was significant prevalence of ABCB1 C-T polymorphisms in patients with HTPR. However it was not an independent risk factor for clopidogrel resistance and also it did not influence adverse cardiovascular outcomes.

Triple Antithrombotic Therapy and Outcomes in Post-PCI Patients Undergoing Non-cardiac Surgery.

Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown. We identified patients undergoing non-cardiac surgeries within 2years of PCI in Veterans Affairs hospitals from 2004 to 2012. We compared perioperative major adverse cardiovascular and cerebrovascular events (MACCE: mortality, myocardial infarction, stroke, revascularization) and bleeding events (in-hospital bleeding, transfusion) between surgeries in patients prescribed triple therapy and DAPT, adjusting for clinical, demographic, and operative characteristics. Among 7811 surgeries, 391 (5.0%) occurred in patients receiving triple therapy. 44 (11.3%) MACCE and 107 (27.4%) bleeding events occurred with surgeries in triple therapy patients, compared to 366 (4.9%) MACCE and 980 (13.2%) bleeding events in DAPT patients. After adjustment, surgery in triple therapy patients was associated with higher rates of MACCE [odds ratio (OR) 1.65, 95% confidence interval (CI) 1.16-2.34] or bleeding (OR 1.52, 95% CI 1.17-1.99) as compared to surgery in DAPT patients. One in twenty post-PCI patients undergoing non-cardiac surgery were on triple therapy. Surgery in these patients was associated with higher MACCE and bleeding events compared to surgery in patients on DAPT, independent of clinical and operative characteristics. These findings identify a high-risk population for surgery, which may warrant increased surveillance for adverse perioperative events.

Factors associated with self-care agency in patients after percutaneous coronary intervention.

The aim of this study is to assess the factors associated with self-care agency in postpercutaneous coronary intervention patients. Patients after percutaneous coronary intervention need to perform self-care to reduce the side effects and increase the quality of life. Self-care agency is considered to be an important factor in guaranteeing self-care actions. In this descriptive study a total number of 300 postpercutaneous coronary intervention patients participated. Data were collected from the four hospitals affiliated with Shahid Beheshti University of Medical Sciences in Iran between February-May 2015. The data were gathered using demographic and basic conditioning factors questionnaire and appraisal of self-care agency scale. Data analysis was performed by anova and t-test. The mean age of the participants was 62·10±(8·14), which included 52·7% men and 47·3% women. Most patients (72%) had good level of self-care agency. Self-care agency had higher level in married and higher income patients. Self-care agency is influenced by economic and marital situation. Identifying factors associated with self-care agency can help healthcare professionals to consider these factors in self-care planning.