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• W2118227957 abstract "Tremendous progress has been achieved over the past decade in the treatment of acute coronary syndromes (ST-segment elevation myocardial infarction [STEMI], non-STEMI [NSTEMI], and unstable angina). In STEMI, primary percutaneous coronary intervention compared with fibrinolytic therapy reduces mortality, reinfarction, stroke, infarct size, and recurrent ischaemia. 1 Stone GW Angioplasty strategies in ST-segment-elevation myocardial infarction: part I. Primary percutaneous coronary intervention. Circulation. 2008; 118: 538-551 Crossref PubMed Scopus (39) Google Scholar In moderate-risk and high-risk patients with NSTEMI, early angiography followed by revascularisation with either percutaneous coronary intervention or coronary artery bypass graft surgery compared with a more conservative approach reduces the rates of death or myocardial infarction, recurrent ischaemia, and rehospitalisation. 2 Mehta SR Cannon CP Fox KA et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005; 293: 2908-2917 Crossref PubMed Scopus (680) Google Scholar , 3 Bavry AA Kumbhani DJ Rassi AN Bhatt DL Askari AT Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006; 48: 1319-1325 Summary Full Text Full Text PDF PubMed Scopus (447) Google Scholar Drug-eluting stents have been shown to be safe in acute coronary syndromes, and, compared with bare-metal stents, reduce clinical and angiographic restenosis, 4 Brar SS Leon MB Stone GW et al. Use of drug-eluting stents in acute myocardial infarction: a systematic review and meta-analysis. J Am Coll Cardiol. 2009; 53: 1677-1689 Summary Full Text Full Text PDF PubMed Scopus (144) Google Scholar further improving quality of life. With expeditious revascularisation recognised as the cornerstone of the treatment of acute coronary syndromes, selecting the optimum pharmacotherapeutic regimen to support the invasive approach becomes imperative. Because platelet activation is intense in acute coronary syndromes, percutaneous coronary intervention, and coronary artery bypass graft surgery, it is not surprising that the thienopyridine clopidogrel, which inhibits ADP-induced platelet activation, when added to aspirin further suppresses ischaemic complications in acute coronary syndromes. 5 Mehta SR Yusuf S Peters RJG et al. for the Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) InvestigatorsEffects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358: 527-533 Summary Full Text Full Text PDF PubMed Scopus (3013) Google Scholar , 6 Sabatine MS Cannon CP Gibson CM et al. for the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)–Thrombolysis in Myocardial Infarction (TIMI) 28 InvestigatorsEffect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA. 2005; 294: 1224-1232 Crossref PubMed Scopus (652) Google Scholar Prasugrel, which is more potent and rapid-acting than clopidogrel, is even better at preventing myocardial infarction and stent thrombosis in patients with an acute coronary syndrome undergoing percutaneous coronary intervention. 7 Wiviott SD Braunwald E McCabe CH et al. for the TRITON-TIMI 38 InvestigatorsPrasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357: 2001-2015 Crossref PubMed Scopus (5406) Google Scholar However, proportional to their potency, these oral agents increase haemorrhagic complications, the occurrence of which has been strongly linked to subsequent mortality. 8 Eikelboom JW Mehta SR Anand SS et al. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006; 114: 774-782 Crossref PubMed Scopus (1108) Google Scholar , 9 Mehran R Pocock SJ Stone GW et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial. Eur Heart J. 2009; 30: 1457-1466 Crossref PubMed Scopus (289) Google Scholar As a result, neither thienopyridine has been shown to improve survival in acute coronary syndromes. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind studyTicagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned. Full-Text PDF" @default.
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• W2118227957 date "2010-01-01" @default.
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• W2118227957 title "Ticagrelor in ACS: redefining a new standard of care?" @default.
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