1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention
Drugs Aging . 2025 Oct;42(10):975-985. doi:10.1007/s40266-025-01235-z.
Abstract
Purpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-termDAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) aftersuccessful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.
Methods: Consecutive patients who underwentsuccessful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group(continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.
Results: A total of 701 patients who underwentsuccessful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewerleft anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of major adverse cardiovascular events (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).
Conclusions: Compared with standard 12-month dualantiplatelet therapy, 1-month dual antiplatelet therapy followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in chronic total occlusion - percutaneous coronary intervention patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Drug Utilization Patterns and Adherenceto Guideline-Directed Therapy in Acute Myocardial Infarction: A ProspectiveObservational Study
International Journal of Life Sciences, Biotechnology andPharma Research Vol. 14, No. 10, October 2025 DOI:10.69605/ijlbpr_14.10.2025.11
ABSTRACT
Background: Acute myocardial infarction (AMI) is aleading cause of morbidity and mortality worldwide. Effective pharmacotherapy plays a crucial role in secondary prevention and improving clinical outcomes. This study evaluates drug utilization patterns in Acute myocardial infarction patients,adherence to guideline-recommended therapies, and factors influencing medication adherence.
Methods: A prospective observational study was conducted on 100 Acute myocardial infarction patients. Demographic data, comorbidities, Killip class, left ventricular ejection fraction (LVEF), and drug utilization were analyzed. Adherence to guideline-recommended therapies, including dual antiplatelet therapy (DAPT), beta-blockers, ACE inhibitors/ARBs, statins, and SGLT2 inhibitors, was assessed based on the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines.
Results: The study included 100 patients (mean age: 54.27 ± 13.51 years), with 82% males. Most (81%) were Killip class I, indicating mild heart failure. Hypertension (34%) and diabetes (24%) were common, while 58% reported tobaccouse. LVEF was <30% in 18% of patients. Thrombolysis was performed in 95%, predominantly with streptokinase (94%). DAPT adherence was high (98%), with ticagrelor (58%) being the most prescribed. Beta-blockers were used in 62%, andACE inhibitors/ARBs in 44%. PCI was performed in 67%, primarily for Left Anterior Descending lesions. AWMI was the most common MI type (45%). Adherence to ACC/AHA guidelines was high for antiplatelets (98%) and statins(96%), but suboptimal for betablockers (62%) and ACE inhibitors/ARBs (44%). Older patients had lower adherence to guideline-directed therapies.
Conclusion: The study demonstrates high adherence toantiplatelets and statins but suboptimal beta-blocker and ACE inhibitor/ARB use. Streptokinase was the preferred thrombolytic. Targeted interventions are needed to improve adherence, especially in older patients, to optimize Acutemyocardial infarction management and outcomes.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Impact of digoxin versus beta-blocker in patients withcoexistent atrial fibrillation and heart failure: a target trial emulation
BMC Med . 2025 Oct 21;23(1):575. doi: 10.1186/s12916-025-04408-0.
Abstract
Background: This study aimed to compare the impact of digoxin versus beta-blocker on adverse clinical outcomes in patients with coexisting atrial fibrillation (AF) and heart failure (HF).
Methods: This study employed a target trial emulation with a clone-censor-weight approach to analyze data from 28,377patients diagnosed with both atrial fibrillation and heart failure in the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between January 1, 2005, and December 31, 2017. Patients were followed up for up to 3years or until the occurrence of clinical outcomes. The exposures were digoxin (N = 5351) versus beta-blocker (N = 7655) within a 90-day grace period. Absolute risks (ARs),risk differences, and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using weighted pooled logistic regression adjusted for demographic characteristics, comorbidities, and medication use. The primary outcome was all-cause mortality, while secondary outcomes includedcardiovascular (CV) mortality, heart failure hospitalization, acute ischemic stroke, acute myocardial infarction, and pacemaker implantation.
Results: Over 3 years, digoxin was associated with a significantly higher risk of all-cause mortality (AR: 51.2% vs. 42.2%; RR: 1.21; 95% CI: 1.17 to 1.26), cardiovascular mortality (AR: 25.1% vs. 21.0%; RR: 1.20; 95% CI: 1.11 to 1.29), and heart failure hospitalization (AR: 29.0% vs. 26.4%; RR: 1.10; 95% CI: 1.04 to 1.16). No significant differences were observed for acute ischemic stroke (AR: 4.3% vs. 4.3%; RR: 1.00; 95% CI: 0.85 to 1.18), acute myocardial infarction (AR: 4.6% vs. 4.3%; RR: 1.04; 95% CI: 0.88 to 1.23), or pacemaker implantation (AR: 1.0% vs. 1.3%; RR: 0.74; 95% CI: 0.54 to 1.01).
Conclusions: In patients with coexisting atrial fibrillation and heart failure, digoxin was associated with significantly higher risks of all-cause mortality, cardiovascular mortality, and heart failure hospitalization compared to beta-blocker.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Dual Versus Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failure
https://www.jacc.org/doi/10.1016/j.jcin.2025.09.018
ABSTRACT
Background: Single antiplatelet therapy (SAPT) is the standard treatment after transcatheter aortic valve intervention (TAVI). However, valve-in-valve transcatheter aortic valve intervention to treat surgical bioprosthesis dysfunction carries an increased thrombotic risk and may benefit from more intensive antithrombotic treatment.
Objectives: The aim of this study is to compare the outcomes of patients treated with dual antiplatelet therapy (DAPT) or Single antiplatelet therapy in the first year after valve-in-valve transcatheter aortic valve intervention.
Methods: Patients treated with valve-in-valve transcatheter aortic valve intervention at 10 participating centers were included and grouped according to treatment with dual antiplatelet therapy or Single antiplatelet therapy, while those treated with oral anticoagulant therapy were excluded.Both clinical and echocardiographic outcomes were analyzed at one-year follow up. A propensity score was developed, then inverse probability of treatment weighting was applied in hazard ratios (HR) estimation, to account for confounders.
Results: A total of 278 patients were included. No differencebetween groups was observed for major adverse cardiac and cerebrovascular events (HR 0.499, 95% confidence interval [CI] 0.182-1.371, P=0.178), major bleedings (HR 0.776, 95% CI 0.172-3.504, P=0.741) and death (HR 0.907, 95% CI 0.272-3.022, P=0.874). Less strokes were observed in patients treated with dual antiplatelet therapy (HR 0.093, 95% CI 0.010-0.831, P=0.033). Additionally, there was no significant difference in moderate or severe structural valve deterioration (1.9% vs 6.0%, P=0.161).
Conclusions:Dual antiplatelet therapy after valve-in-valve transcatheter aortic valve intervention may be associated with a lower one-year incidence of stroke, while no significant difference was observed for other major ischemic and bleeding outcomes or for premature valve deterioration.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Comparison between clopidogrel and ticagrelor in CYP2C19 loss-of-function alleles coronary artery disease andstroke patients: a meta-analysis
Eur J Clin Pharmacol. 2025 Sep;81(9):1241-1256.
Abstract
Background: It is suggested that in patientswith coronary artery diseases (CAD) and stroke, the use of ticagrelor and aspirin may perform better than clopidogrel and aspirin regarding the risk of thrombosis/embolism, including recurrent myocardial infarction (MI) andcardiovascular death, especially in those carrying CYP2C19 loss-of-function (LOF) alleles. Therefore, we conducted the present systematic review and meta-analysis to investigate the effect of clopidogrel and ticagrelor in coronaryartery diseases and stroke patients with CYP2C19 LOF alleles (poor metabolizers of clopidogrel).
Methods: We performed the current systematicreview and meta-analysis by searching for all eligible publications on PubMed, Web of Science, and Scopus from inception to November 2024. A search strategyemploying three primary keywords in conjunction with their corresponding Medical Subject Headings (MeSH) terms: "Ticagrelor" AND "Clopidogrel" AND"CYP2C19" (PROSPERO ID CRD420251050533). We implemented the odds ratio (OR) as an effect estimate for the dichotomous variables. The analysis was done at 95% confidence intervals (CI), and the p-value was significant if it was less than or equal to 0.05.
Results: Using clopidogrel was associated withan increased risk of thrombosis/embolism compared with ticagrelor, showing odds ratio = 1.78 (95%CI, 1.08,2.95; p = 0.02). Also, clopidogrel led to an increased risk of stroke, whether when used in stroke or coronary artery diseases patients with CYP2C19 LOF alleles, compared with ticagrelor, with an overall odds ratio = 1.43 (95%CI, 1.23, 1.66; p < 0.00001) and a higher rate of MI with odds ratio = 1.53 (95%CI, 1.22, 1.92; p = 0.0003). No significant difference was observed between the two groups (clopidogrel andticagrelor) in stroke or coronary artery diseases patients with odds ratio = 0.98 (95%CI, 0.79, 1.22; p = 0.87). Also, no significant difference was observed between bothgroups regarding the risk of minor bleeding in stroke or coronary artery diseases patients with odds ratio = 0.66 (95%CI, 0.42, 1.05; p = 0.08) and any types of bleeding (major or minor bleeding) with overall odds ratio = 0.81 (95%CI, 0.54, 1.21; p = 0.3) and I2 = 88%, p < 0.00001.
Conclusion: The meta-analysis of the selected articles indicated a preference for ticagrelor over clopidogrel in patients with stroke or coronary artery diseases possessing CYP2C19 LOF alleles. The reduced incidence of thrombosis/embolism and associated events, such as strokeand MI, was noted in individuals administered ticagrelor in comparison to those receiving clopidogrel. Bleeding remains a concern with ticagrelor; however, current studies indicate its safety since there are no significant changes in therisk of minor and major bleeding and ICH compared to clopidogrel.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysisof randomised controlled trials
Lancet. 2025 Sep 13;406(10508):1128-1137.
Abstract
Background: The effects of β-blocker therapy on clinicaloutcomes in patients with myocardial infarction and mildly reduced (40-49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced left ventricular ejectionfraction (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced left ventricular ejection fraction. We aimed to assess the efficacy of β blockers in patientswith myocardial infarction and mildly reduced left ventricular ejection fraction during the index hospitalisation.
Methods: We conducted an individual patient-levelmeta-analysis of patients with mildly reduced left ventricular ejection fraction and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction(randomisation within 14 days) and had mildly reduced left ventricular ejection fraction. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025).A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heartfailure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480).
Findings: 1885 patients with myocardial infarction andmildly reduced left ventricular ejection fraction were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patientswere assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in theβ-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58-0·97]; p=0·031). No heterogeneity between thetrials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98).
Interpretation: In patients with acute myocardial infarctionwith mildly reduced left ventricular ejection fraction without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents inpatients with myocardial infarction with reduced left ventricular ejection fraction to the subgroup with mildly reduced left ventricular ejection fraction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Angiotensin receptor-neprilysin inhibitors and mortality among patients with heart failure with reducedejection fraction
https://doi.org/10.1016/j.amjcard.2025.08.063
Abstract
Background
While trial evidence supports the benefit of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in heart failurewith reduced ejection fraction (HFrEF), its effectiveness in routine clinical practice is less explored. This study investigated the relative and absolute effectiveness of ARNI in patients with heart failure with reduced ejectionfraction.
Methods
This nationwide Danish database study included patients with left ventricular ejection fraction (LVEF) ≤40%,2018–2023. Using a prevalent new user design, 2,446 ARNI initiators were matched 1:2 to 4,892 users of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) based on propensity scores, age, LVEF,and NT-proBNP. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality and hospitalization.
Results
There were 279 deaths among ARNI initiators(5.6/100 person-years) and 533 among ACE-I/ARB users (6.7/100 person-years), yielding a hazard ratio (HR) of 0.85 (95% CI, 0.74–0.98) for all-cause mortality. A significant interaction was observed for recent hospitalization (p=0.04),with ARNI yielding a lower hazard ratio in this group. hazard ratios were otherwise consistent across age, sex, left ventricular ejection fraction, NT-proBNP, NYHA class, ischemic heart disease, chronic kidney disease, and type2 diabetes. The largest absolute mortality reductions were seen in subgroups with recent hospitalization, NYHA class III–IV, and severely elevated NT-proBNP. ARNI was also associated with a lower risk of cardiovascular death (HR, 0.81; 95% CI, 0.65–0.99), but not with other secondary outcomes.
Conclusions
In this study, ARNI was associated with a 15% reduction in all-cause mortality vs ACE-I/ARB. Patients with advanced orsymptomatic heart failure appeared to experience the greatest absolute benefit.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
The use of beta-blockers for heart failure with reduced ejection fraction in the era of SGLT2 inhibitors - are westill afraid to up-titrate?
Heart Vessels . 2025 Sep;40(9):797-804.doi: 10.1007/s00380-025-02525-7.
Abstract
Beta-blockers are one of the four major pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The therapy has presented the best effects when up-titrated to evidence-based target doses. Despite their proven benefits, physicians have traditionally shown reluctance to up-titrate beta-blockersbecause of their negative inotropic and chronotropic effects. The effects of newly introduced sodium-glucose cotransporter 2 inhibitors (SGLT2I) in treating heart failure with reduced ejection fraction might open more room for adequate beta-blockers up-titration. The goal of this study was to evaluate the up-titration practice, and impact of target doses of beta-blockers in patients with heart failure with reduced ejection fraction receiving SGLT2I. This is aprospective cohort study involving patients with heart failure with reduced ejection fraction receiving SGLT2I therapy. Baseline use and dosing to the evidence-based targets were examined. We compared the groups of patientsreceiving maximally titrated beta-blockers versus incompletely titrated. Primary outcome was composite of (1) rehospitalization or revisit to emergency unit due to the heart failure; (2) all-cause death and major adverse cardiacevents (MACE). Secondary outcomes were heart rate at rest, left ventricular ejection fraction, NT-proBNP, and NYHA status at 6 and 12 months of follow-up. Study endpoints were documented via telephone interviews, regular outpatientfollow-up, or by electronic hospital records. This study included a total of 458 patients with median follow-up time of 365 (186-502) days. A total of 122 (26.6%) patients hadbeta-blockers maximally up-titrated. The results show that adherence to maximal target doses of β-blocker therapy significantly reduces hazard of death or major adverse cardiac events comparing to not using maximal doses of β-blocker (factor 0.43). Hazard reduction was not statistically significant for composite of rehospitalization or revisit to emergency unit due to HF. Maximal doses of beta-blockers did not result in a significant decrease in resting heart rate. Our real-world data have highlighted the prevalence of incomplete titration of beta-blockers. Although it has been shown that evidence-based target dosing of beta-blockersreduces death and major adverse cardiac events, there is still room for improvement with up-titrating beta-blockers in eligible patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial
Eur Heart J 2025 Aug 1;46(29):2894-2902. doi: 10.1093/eurheartj/ehaf170.
Abstract
Background and aims: This study aims to report theeffects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI).
Methods: Changes in heart rate and blood pressurefrom baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in heart rate and blood pressure and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively.
Results: β-blocker interruption was associated withsignificant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P <.001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting heart rate [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruptiongroup. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01-1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%-9.32%, P = .014) when randomized to β-blocker interruption.
Conclusions: Interruption of β-blocker treatment after an uncomplicated myocardial infarction led to a sustained increase in blood pressure and heart rate with potentially deleterious effects on outcomes, especially in patients with history of hypertension.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
ST-elevation myocardial infarction and air pollution: relationship between hourly air pollution and cardiovascular risk factors
J Cardiovasc Med (Hagerstown). 2025 Aug 1;26(8):412-419.
Abstract
Objective: Air pollution contributes to cardiovascular diseases through oxidative stress, inflammation, autonomicnervous system imbalance, and direct particle translocation. This study examines the relationship between air pollution parameters and risk factors in patients presenting with (STEMI).
Methods: This prospective, cross-sectional studyincluded ST-elevation myocardial infarction patients aged at least 18 years in a tertiary ST-elevation myocardial infarction hospital. Demographics, comorbidities, seasonal variations, comorbidities, vital signs, hourly air pollution and weather parameters on admission, hospital length of stay, treatment modalities, and outcomes were recorded.
Results: Among 1413 patients, 75.1% were men. The median age of female patients [65 (IQR: 58-73)] was significantly higher that of than males [55 (IQR: 50-66), P < 0.001].Median air quality index (AQI) [53 (IQR: 37-55)] and particulate matter (PM2.5) levels [18 (IQR: 11-27)] on admission were above Environmental Protection Agency limits. Patients with prior coronary artery disease (P = 0.037)and female patients (P = 0.018) had significantly lower PM10 exposure. PM2.5 levels were significantly higher in patients aged >75 years [20.5 (IQR: 13-29)] than in youngerpatients [18 (IQR: 11-27), P = 0.022]. Those recommended for coronary artery bypass grafting had lower sulfur dioxide levels [6 (IQR: 4-9) vs. 8 (IQR: 5-13), P = 0.003].
Conclusion: When air quality index and particulatematter 2.5 levels exceed EPA limits, they may interact with cardiovascular risk factors such as age, sex, and comorbidities, contributing to the development ofST-elevation myocardial infarction. Elderly individuals, women, and those with a history of cardiovascular disease may be more susceptible to the adverse effects of air pollution.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention
Drugs Aging. 2025 Aug 2. doi: 10.1007/s40266-025-01235z.
Abstract
Purpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) aftersuccessful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing Percutaneous Coronary Intervention.
Methods: Consecutive patients who underwent successful elective chronic total occlusion Percutaneous CoronaryIntervention were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.
Results: A total of 701 patients who underwent successful chronic total occlusion Percutaneous Coronary Interventionwere enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).
Conclusions: Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in chronic total occlusion Percutaneous Coronary Intervention patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
SGLT2 inhibitor with and without ALDosterone AntagonIst for heart failure with preserved ejection fraction:Design paper
ESC Heart Fail. 2025 Aug;12(4):3134-3144. doi: 10.1002/ehf2.15294
Abstract
Background: Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists(MRA) reduce heart failure (HF) events in patients with heart failure and mildly reduced or preserved ejection fraction (HFmr/pEF). The randomized comparison of Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA)combination versus SGLT2i or MRA alone requires further testing in heart failure and mildly reduced or preserved ejection fraction.
Aim: To compare the efficacy (NT-proBNP change as primary outcome) and safety (potassium, creatinine, and blood pressure changes) of dapagliflozin/spironolactone combination versus dapagliflozin alone (primary comparison) and spironolactone alone (exploratory comparison).
Methods: SOGALDI-PEF (SOdium-Glucose cotransporter 2 inhibitor, ALDosterone AntagonIst, or both for heart failure with preserved ejection fraction; NCT05676684), a proof-of-concept investigator-initiated two-centre randomized cross-over trial comparing three arms (dapagliflozin, spironolactone, or both) for three periods of 12 weeks each intercalated by a wash-out period of 4 weeks. After two independent trials demonstrating efficacy of SGLT2i in heart failure and mildly reduced or preserved ejection fraction, amid-trial protocol amendment dropped the spironolactone alone sequence and reduced the wash-out period to 1 week. A sample size of 108 patients was estimated to provide 80% power, at a 0.05 alfa level, to detect a 0.15 LogNT-proBNPdifference between the spironolactone/dapagliflozin combination and dapagliflozin alone sequence.
Results: SOGALDI-PEF included 108 patients with a median age of 76 years, 57% women, 42% with atrial fibrillation, 46% with type 2 diabetes, 33% having an eGFR below 60 mL/min/1.73m2, and 93% having an ejection fraction ≥ 50%. The median serum potassium was 4.3 mmol/L, and the median NT-proBNP was 764 pg/mL. Most patients were treated with renin-angiotensin blockers (68%), beta-blockers(70%) and loop diuretics (69%). Compared to other heart failure and mildly reduced or preserved ejection fraction trials, SOGALDI-PEF patients were older, were more frequently women, had a high prevalence of atrial fibrillation, and had more often a preserved ejection fraction.
Conclusions: SOGALDI-PEF will be the first trial in heart failure and mildly reduced or preserved ejection fraction to test the combination of dapagliflozin/spironolactone vsdapagliflozin alone in a randomized manner. SOGALDI-PEF will provide information on the potential efficacy and safety of concomitant administration of spironolactone with dapagliflozin vs dapagliflozin alone in an elderly population with heart failure and mildly reduced or preserved ejection fraction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Combined effects of clonal hematopoiesis of intermediate potential and P2Y12 inhibitors on outcomes of patients with ST-segment elevation myocardial infarction: A prospective study
https://doi.org/10.1016/j.phrs.2025.107852
Abstract
Clonal hematopoiesis of intermediate potential (CHIP) is a prominent risk factor for atherosclerosis, but effectivemedications for Clonal hematopoiesis of intermediate potential -associated risk are still lacking. This study aimed to assess prognostic impacts of P2Y12 inhibitors in the context of Clonal hematopoiesis of intermediate potential with aprospective cohort of 1332 patients of ST-segment elevation myocardial infarction (STEMI). Using targeted deep sequencing, Clonal hematopoiesis of intermediate potential was defined by any Clonal hematopoiesis of intermediatepotential -gene mutations with variant allele frequency (VAF) > 2%. Patients were stratified into four groups according to Clonal hematopoiesis of intermediate potential status and the prescribed types of P2Y12 inhibitors (ticagrelor and clopidogrel). The primary outcome was major adversecardiovascular events (MACE), a composite of death, recurrent MI, re-hospitalization due to heart failure and ischemic stroke. During a median follow-up of 1458 days, Clonal hematopoiesis of intermediate potential patientsreceiving ticagrelor exhibited lower risk of major adverse cardiovascular events (hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.20–0.88, P = 0.022), followed bynon- Clonal hematopoiesis of intermediate potential patients on clopidogrel (HR: 0.60, 95% CI: 0.41–0.88, P =0.010) and ticagrelor (HR: 0.66, 95% CI: 0.44–0.99, P = 0.044), as compared to Clonal hematopoiesis of intermediate potential patients on clopidogrel, with significantinteractions detected between ticagrelor and Clonal hematopoiesis of intermediate potential (P interaction =0.015, relative excess risk due to interaction: -1.53, 95% CI: -4.91– -0.66). In sum, Clonal hematopoiesis of intermediate potential and P2Y12 inhibitors jointly affected outcomes of STEMI patients, and ticagrelor was associated to greater risk reduction in the presence of Clonal hematopoiesis of intermediate potential. These findings would promote more personalized antiplatelet medications for patients with ST-segment elevation myocardial infarction.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Early β-Blocker Use and Clinical Outcomesin Acute Myocardial Injury: A Retrospective Cohort Study
Am J Med. 2025 Jul;138(7):1090-1098.e6.
Abstract
Background: Acute myocardial injury is defined by elevated cardiac troponin levels with a rising and/or falling pattern, and is associated with increased mortality risk compared topatients without myocardial injury. The role of β-blockers in patients with acute myocardial injury remains unclear.
Methods: This multicenter, retrospective cohort study used data from the Tianjin Health and Medical Data Platform to assess the impact of early β-blocker use on 1-year all-causemortality and major adverse cardiovascular events (MACE) in acute myocardial injury patients, employing a new user and target trial emulation design. Propensity score matching was applied, and Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).
Results: After propensity score matching, a total of 25,966 participants were included: 8667 to the β-blockergroup and 17,299 to the non-β-blocker group. A total of 4113 deaths (15.8%) and 5795 major adverse cardiovascular events (22.3%) occurred. Compared with nonusers, β-blocker was associated with the reduced risk of all-cause mortality(HR: 0.89, 95% CI: 0.83-0.95) and major adverse cardiovascular events (HR: 0.90, 95% CI: 0.85-0.95).In the subgroup analysis, β-blockers were associated with a significantly reduced risk of mortality in patients without stroke (HR 0.85, 95% CI: 0.78-0.93), while no significant association was observed in patients with stroke (HR 1.04, 95% CI: 0.93-1.16).
Conclusions: Early use of β-blockers is associated with the reduced risk of 1-year mortality in patients with acute myocardial injury. To more accurately assess the therapeuticeffects, prospective trials are necessary, and these data provide key research directions for future trials.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
A Retrospective Cohort Study on Long-TermOutcomes of Ticagrelor Versus Clopidogrel After Retrograde Percutaneous Coronary Intervention for Chronic Total Occlusion
Am J Cardiovasc Drugs. 2025 Jul 12. doi:10.1007/s40256-025-00750-z.
Abstract
Background: Chronic total occlusion (CTO) affects 15-25% of patients undergoing coronary angiography, and successful percutaneous coronary intervention (PCI) can improve ischemia, angina symptoms, and overall quality of life. However, Chronic total occlusion - percutaneous coronary intervention is a complex procedure with higher risks of acute thrombosis, restenosis, and long-term thrombosis due to factors such as longer lesion length, calcification, and the need for more stents. Dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention, but theoptimal regimen for Chronic total occlusion, particularly in patients with chronic coronary syndrome, remains under debate. Although more potent P2Y12 inhibitors such as ticagrelor may offer benefits in some cases, recent studieshave shown mixed results.
Objective: This study aimed to assess the effect of potent Dual antiplatelet therapy on long-term outcomes in patients with Chronic total occlusion undergoing retrograde percutaneous coronary intervention.
Method: We conducted a retrospective analysis of836 consecutive patients who underwent elective retrograde Chronic total occlusion - percutaneous coronary intervention at a single center between January 2011 and April 2023. We compared patient and lesion characteristics,procedural details and results, and long-term outcomes between patients who received ticagrelor and those who received clopidogrel after retrograde Chronic total occlusion - percutaneous coronary intervention.
Result: Clinical follow-up was available in 767 (91.2%) patients, with a median follow-up of 1041 days (range 531-1511). The risk of major adverse cardiovascular events was significantly lower in patients receiving ticagrelor than in those receiving clopidogrel (8.8% vs. 18.5%, p = 0.005),primarily due to reductions in all-cause mortality (1.9% vs. 8.1%, p = 0.009) and cardiac death (0.6% vs. 5.8%, p =0.012).
Conclusion: Dual antiplatelet therapy with ticagrelor may represent a safe and efficient management strategy for patients undergoing retrograde Chronic total occlusion - percutaneous coronary intervention.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Effects of moderate physical trainingprogram in post-myocardial infarction patients with arterial hypertension
Eur J Transl Myol. 2025 Jul 10. doi: 10.4081/ejtm.2025.13943
Abstract
The clinical effectiveness of physical training in a cardiac rehabilitation program (CRP) was assessed in hypertensive(AH), post-myocardial infarction (MI) patients. 206 patients were randomized into a physically trained group (PhTG, n=102) and an untrained, control group (CG, n=104). All patients received standard drug therapy. physically trained group patients performed mild callisthenic exercises and moderately intensive bicycle exercise three times/week for one year. Compared to control patients, physically trained group patients had significant changes in exercise capacity (duration +38%, p<0.001; total work +63.6%, p<0.001); rate-pressure product (-8.2%, p<0.01); left ventricular ejectionfraction (+7.6%, p<0.001); left ventricular stroke volume (+5.1%, p<0.01). Resting BP decreased in physically trained group patients (systolic BP, -3.1%, p<0.05; diastolic BP, -3.5%, p<0.001), but increased in control group patients (systolic BP, +3.1%, p<0.05; diastolic BP +3.4%, p<0.05). physically trained group patients had fewer myocardial ischemic episodes, including painless ischemia during exercise, fewer anginaattacks, less nitroglycerin consumption, improved quality of life, fewer cardiovascular events (-50%, p<0.05), and days of absence from work (-43.2%, p <0.05). Thus, supplementing a cardiac rehabilitation program with moderate exercise improved Blood Pressure, work capacity, cardiac function, and quality of life in hypertensive, post-myocardialinfarction patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
The 2025 Guideline for the Management of Patients With Acute Coronary Syndromes: Asian Perspective
https://www.jacc.org/doi/full/10.1016/j.jacc.2025.04.011
The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for theManagement of Patients with Acute Coronary Syndromes introduces key updates that may influence global clinical practice. Given Asia’s immense population and regional diversity, assessing how these U.S.-based guidelines translate into real-world application is essential.Although grounded in robust clinical trial evidence, their relevance in Asia varies due to differences in demographics, access to treatment, health care infrastructure, and cultural context. This paper explores how these updatesintersect with regional realities, focusing on 4 key areas: 1) antithrombotic strategies; 2) lipid-lowering therapy; 3) multivessel revascularization; and 4) mechanical circulatory support in cardiogenic shock.
In South Asia, ACS management is shaped by a high burden of cardiometabolic risk, earlier disease onset, and major socioeconomic status (SES) disparities. One-thirdof patients receive care in urban tertiary centers, but most rely on under-resourced hospitals in smaller towns. Evidence-based practices are more common in high- socioeconomic status settings; elsewhere, cost and practicality drive care decisions.
1. Antithrombotic therapy is mostly dictated by affordability. Clopidogrel remains the dominant P2Y12 inhibitor. Ticagrelor is increasingly used in high-socioeconomic status urban areas, supported by local production, but is rare in rural settings and Pakistan. Prasugrel is used in <10% of patients, due to bleeding risk in those with low body weight. DAPT typically lasts 12 months; shorter courses are reserved for high bleeding risk.
2. The Lipid Association of India recommends one of the world’s most aggressive lipid-lowering strategies, using moderate- or high-intensity statins plus ezetimibe to achieve LDL-C targets of <50 mg/dL for very high risk and <30 mg/dL for extreme risk individuals, based on atheroscleroticcardiovascular disease and/or multiple high-risk features upon ACS presentation. If <20% additional LDL-C reduction is needed, bempedoic acid or bile acid sequestrants may be used; if >20%, a PCSK9i is preferred. PCSK9i and inclisiran remain largely unaffordable, though use has grown over the past year among higher socioeconomic groups, guided by the 2024 Indian Consensus Statement. Lipoprotein(a) testing is recommended at least once in all adults beginning at age 18 years.
3. Revascularization strategies depend on available infrastructure. In urban high- socioeconomic status settings, primary PCI with radial access is preferred, with staged PCIfor nonculprit lesions. In rural areas, fibrinolysis—typically tenecteplase or streptokinase—remains the primary treatment due to limited PCI access.
4. Mechanical circulatory support availability is minimal.microaxial flow pumps are present in select tertiary centers but are rarely used due to cost and training requirements. Intra-aortic balloon pump use is the mainstay. Venoarterial extracorporeal membrane oxygenation is availableonly in specialized centers, with limited use due to high cost, low expertise, and delayed presentation.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website
Exploring the Impact of Beta-Blockers Post-Acute Myocardial Infarction in Patients with Preserved Ejection Fraction: A Meta-Analysis
J. Clin. Med. 2025, 14(11), 3969; https://doi.org/10.3390/jcm14113969
Abstract
Background/Objectives: Previous research has establishedthat beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patientswith preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted asystematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with acute myocardial infarction andpreserved left ventricular ejection fraction.
Methods: A comprehensive literature search was conductedacross PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: “preserved”, “myocardial infarction”, and “beta-blocker”. Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account forthe study’s heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of p < 0.05.
Results: Beta-blocker therapy was significantly associatedwith a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61–0.88, p = 0.001) and an HR of 0.78 (95% CI: 0.67–0.91, p = 0.002). Similarly, beta-blockeradministration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95%CI: 0.68–0.84, p < 0.00001) and an HR of 0.76 (95% CI: 0.59–0.99, p = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of majoradverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75–0.95, p = 0.004)and an HR of 0.84 (95% CI: 0.71–0.99, p = 0.04).
Conclusions: The current meta-analysis suggestsa potential beneficial association between beta-blocker use and outcomes in patients with acute myocardial infarction and preserved left ventricular ejection fraction, including lower rates of all-cause mortality, cardiovascularmortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm thesefindings, particularly in distinguishing outcomes among patients with and without heart failure.Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website
Antiplatelet and Anticoagulant Therapy in the 2025 ACC/AHA Guideline for Acute Coronary Syndromes: KeyRecommendations
JACC. 2025 Jun, 85 (22) 2074–2078
The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for theManagement of Patients With Acute Coronary Syndromes (ACS), published in this issue of JACC, replaces the prior U.S. guidelines on the management of ST-segment and non–ST-segment elevation ACS. The new guideline provides anexcellent evidence-based framework for diagnosis and management of type I ACS (ie, in the setting of atherothrombosis). This Guideline Commentary highlightsthe key recommendations related to antithrombotic therapy, compares the 2025 guideline with prior American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC) recommendations, and offers reflections on recent changes and opportunities for further clarification.
With respect to antiplatelet therapy, early initiation ofaspirin and an oral P2Y12 receptor inhibitor remain Class 1 recommendations. The new guideline recommends either ticagrelor or prasugrel (Class 1, without distinction between the two) as the preferred P2Y12 inhibitor in ST-segmentelevation myocardial infarction (STEMI) or non–ST-segment elevation myocardial infarction (NSTEMI). If these agents are contraindicated, not tolerated, unaffordable, or unavailable, clopidogrel is recommended. The initiation of oral P2Y12 inhibitors before transfer to the catheterization laboratory isrecommended if there is an expected delay of >24 hours (Class 2b). In patients undergoing percutaneous coronary intervention (PCI) who have not received a P2Y12 inhibitor, intravenous cangrelor may be reasonable (Class 2b).The recommendations for the duration of dual antiplatelet therapy (DAPT) following ACS are more nuanced: The guideline recommends a default DAPT duration of 1 year after ACS for patients without high bleeding risk (Class 1),but where bleeding risk is a concern, it recommends ticagrelor monotherapy 1 month after PCI (Class 1) .Clopidogrel-based DAPT is recommended for patientswith STEMI who receive fibrinolytic therapy. In patients with NSTEMI who undergo medical therapy alone, the guideline gives a Class 1 recommendation for aspirin and ticagrelor.
In conclusion, the 2025 ACC/AHA guideline for diagnosing and managing ACS provides thoughtful, practical, and actionable recommendations for antithrombotic therapy. When paired with available resources and individualcharacteristics and values of patients, they can help clinical practice and medical practitioners until further data emerges.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website.
Pragmatic Use of Ticagrelor: ImprovingOutcomes in Medical Management of Acute Coronary Syndrome (PracTiCal India Study)
Journal of Indian College of Cardiology ():10.4103/jicc.jicc_73_24, June 05, 2025. | DOI: 10.4103/jicc.jicc_73_24
Abstract
Background:
The utilization of ticagrelor in the medical management ofacute coronary syndrome (ACS) has been extensively explored in interventions such as percutaneous coronary intervention. However, its use in acute coronarysyndrome without intervention remains inadequately explored. The PracTiCal India Study was initiated to address this gap, aiming to optimize ticagrelor’s application in medical management in treating various cardiovascularconditions, particularly acute coronary syndrome.
Methods:
This questionnaire-based survey was conducted amongcardiologists in India. The questionnaire consisted of eight questions specifically designed to collect data on the most effective and efficient methods for managing acute coronary syndrome, with a focus on the optimal utilization of ticagrelor. The survey results were subsequently discussed in a round table meeting by a panel of experts.
Results:
A total of 103 cardiologists completed the survey. Among theparticipants, 70.9% preferred ticagrelor for not reperfused ST-segment elevation myocardial infarction (STEMI) and 58.3% of participants chose it for nonrevascularized non-STEMI (NSTEMI). The participants commonly consideredmultiple stents (76.7%), a high risk of stent thrombosis (74.8%), and a history of previous revascularization (63.1%) as the most significant factors for initiating ticagrelor. The most common factors limiting the effective use of ticagrelor were bleeding risk (63.1%) and cost (52.4%). In addition, 43.7%preferred transitioning ACS patients to ticagrelor without reperfusion after using a different P2Y12 inhibitor.
Conclusion:
The study highlights ticagrelor as the preferred P2Y12inhibitor for both not reperfused STEMI and NSTEMI cases, reflecting its widespread acceptance among cardiologists. The decision to employ ticagrelor is primarily influenced by stent-related complications and the patient’s comorbidity profile. However, the practical application of ticagrelor is often hindered by concerns regarding hemorrhagic complications and the cost of therapy, particularly in scenarios involving patients who have not undergonerevascularization procedures.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website.
