Management of patients after primary percutaneous coronary intervention for myocardial infarction

  title={Management of patients after primary percutaneous coronary intervention for myocardial infarction},
  author={Fatima Dalal and Hasnain M. Dalal and Christos Voukalis and Manish M. Gandhi},
  journal={British Medical Journal},
#### What you need to know For those who present with an acute ST elevation myocardial infarction (STEMI) in the UK, nearly 90% are treated with a primary angioplasty within 90 minutes of arrival at hospital.1 One out of every seven deaths is due to coronary heart disease, with one person having a “heart attack” every 40 seconds, based on US data.2 In the UK, 288 per 100 000 people visit hospital with a suspected heart attack each year.3 Patients are usually discharged three days after… 
Further points to consider after primary percutaneous coronary intervention
The management of patients who have had primary percutaneous coronary intervention for myocardial infarction is summarized, but what drug should be used and at what dose is not mentioned.
Comprehensive analysis of predictive factors for rapid angiographic stenotic progression and restenosis risk in coronary artery disease patients underwent percutaneous coronary intervention with drug‐eluting stents implantation
This study aimed to explore the correlation of baseline, procedural, and postprocedure characteristics with the risk of rapid angiographic stenotic progression (RASP) and restenosis in coronary
Gastrointestinal protection with dual antiplatelet therapies
  • I. Beales
  • Medicine, Biology
    British Medical Journal
  • 2018
Dalal and colleagues provide a concise update on the pharmacological and behavioural management of patients after a myocardial infarction, which is associated with poorer prognosis in this patient population.
Primary care management following an acute myocardial infarction
David Warriner and Mohanned Al-Matok explain how to treat a patient who has returned from acute care and how to diagnose and treat patients who have returned from intensive care.
Authors’ reply to Sharvill and Beales
We thank Sharvill and Beales for drawing attention to gastroprotection for dyspepsia associated with dual antiplatelet therapy and a higher bleeding risk in elderly people, which we referred to in
The role of perseverative negative thinking in predicting depression, anxiety and quality of life in people with coronary heart disease.
............................................................................................................................................. 2 ACKNOWLEDGEMENTS
An advanced nurse-led clinic for patients following percutaneous coronary intervention
The post-PCI clinic is described and an overview of the patient profile and outcomes over a 2-year period is provided, with an emphasis on advanced nursing roles and patient symptoms.
MiR-134-5p Regulates Myocardial Apoptosis and Angiogenesis by Directly Targeting KDM2A After Myocardial Infarction.
Research revealed that knockdown of miR-134-5p increased KDM2A expression, thereby suppressing myocardial apoptosis and promotingMyocardial angiogenesis.
Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention
Risk factors for sub-optimal continuity were identified and action should be taken to educate patients, reconcile discharge plans and organise post-discharge services.
Impact of cardiac rehabilitation on cardiac mortality.


Complete Immediate Revascularization of the Patient With ST-Segment–Elevation Myocardial Infarction Is the New Standard of Care
Opposing Viewpoint, see p 1574 Approximately half of patients with ST-segment–elevation myocardial infarction (STEMI) have angiographically significant multivessel disease and, in these patients,
Not So Fast: Complete Revascularization of the ST-Segment-Elevation Myocardial Infarction Patient Is Not Yet Proven.
In most advanced healthcare systems, primary percutaneous coronary intervention has replaced thrombolysis as the optimal therapy for patients presenting with ST-segment–elevation acute myocardial infarction and the frequent discovery of nonculprit vessel lesions has fueled enthusiasm among interventional cardiologists to implant additional stents at the time of PPCI.
The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP).
While survival benefit from more intensive management reduced with older age, better survival was associated with intensive management at all ages highlighting the requirement to improve standard of care in older patients with ACS.
Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010.
There have been substantial reductions in in-hospital mortality rates from 2003 to 2010 across all age groups including the very elderly and age-dependent inequalities in the management of ACS were apparent.
Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association
Effective stroke prevention (which is essentially OAC) can then be offered to AF patients with ≥1 stroke risk factor(s), with treatment decisions made in consultation with patients and incorporating their preferences.
Triple antithrombotic therapy following an acute coronary syndrome: prevalence, outcomes and prognostic utility of the HAS-BLED score.
  • J. Smith, M. Wieloch, Jesper van der Pals
  • Medicine, Biology
    EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
  • 2012
TT was relatively common following acute coronary syndrome and was associated with a threefold increase in major bleeding compared to DAPT at one year and the HAS-BLED risk score predicted bleeding events with moderate accuracy.
Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status)
Although depression in patients with AMI is associated with increased long-term mortality, this association may be confined to patients with untreated depression.
New‐Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long‐Term Follow‐Up: A Nationwide Study
New‐onset AF after first‐time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths, and focus on the prognostic impact of post‐infarct AF is warranted.
EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries
A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes.