ABSTRACT
Background After a loading dose of ticagrelor, the rate of high on-treatment platelet reactivity remains elevated, which increases periprocedural myocardial infarction and injury. This indicates that faster platelet inhibition with crushed ticagrelor (CTIC) or eptifibatide is needed to reduce high on-treatment platelet reactivity. The efficacy of CTIC versus eptifibatide bolus plus clopidogrel is unknown. Methods and Results A total of 100 P2Y12 naïve, troponin-negative patients with acute coronary syndrome were randomized to CTIC (180 mg) versus eptifibatide bolus (180 µg/kg×2 intravenous boluses) plus clopidogrel (600 mg) at the time of percutaneous coronary intervention. High on-treatment platelet reactivity was markedly higher with CTIC versus eptifibatide bolus plus clopidogrel (42% versus 0%; P<0.001) at 30 minutes and persisted up to 2 hours (12% versus 0%; P=0.01, respectively). Platelet aggregation by adenosine diphosphate dropped faster from baseline with eptifibatide bolus plus clopidogrel versus CTIC (0.5 versus 2 hours, respectively) and was higher with CTIC versus eptifibatide bolus plus clopidogrel at 0.5, 2, and 4 hours after loading dose (53±12% versus 1.3±2%; 35±11% versus 0.34±1.0%; and 23±9% versus 3.5±2%, respectively; P<0.001). Eptifibatide bolus plus clopidogrel, but not CTIC, significantly inhibited platelet aggregation induced by thrombin-receptor activating peptide. Periprocedural myocardial infarction and injury was higher with CTIC versus eptifibatide bolus plus clopidogrel (48% versus 28%, respectively; P=0.035). Post-percutaneous coronary intervention hemoglobin levels were not different between groups. Conclusions Eptifibatide bolus plus clopidogrel led to faster and more potent platelet inhibition than CTIC and reduced periprocedural myocardial infarction and injury in troponin-negative acute coronary syndrome patients undergoing percutaneous coronary intervention, with no significant hemoglobin drop after percutaneous coronary intervention. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02925923.
Subject(s)
Acute Coronary Syndrome/drug therapy , Clopidogrel/administration & dosage , Eptifibatide/administration & dosage , Platelet Aggregation Inhibitors/administration & dosage , Ticagrelor/administration & dosage , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/surgery , Aged , Drug Combinations , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , Prospective Studies , Single-Blind Method , Troponin/bloodSubject(s)
Accessory Atrioventricular Bundle/diagnosis , Heart Rate , Tachycardia, Reciprocating/diagnosis , Tachycardia, Supraventricular/diagnosis , Accessory Atrioventricular Bundle/physiopathology , Accessory Atrioventricular Bundle/surgery , Action Potentials , Catheter Ablation , Electrocardiography, Ambulatory , Electrophysiologic Techniques, Cardiac , Humans , Male , Middle Aged , Predictive Value of Tests , Tachycardia, Reciprocating/physiopathology , Tachycardia, Reciprocating/surgery , Tachycardia, Supraventricular/physiopathology , Tachycardia, Supraventricular/surgery , Time FactorsSubject(s)
Myocardial Infarction/epidemiology , Myocardial Infarction/physiopathology , Takotsubo Cardiomyopathy/epidemiology , Takotsubo Cardiomyopathy/physiopathology , Adolescent , Adult , Aged , Case-Control Studies , Databases, Factual/trends , Female , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Retrospective Studies , Risk Factors , Takotsubo Cardiomyopathy/diagnosis , United States/epidemiology , Young AdultABSTRACT
We describe an adult patient in whom live three-dimensional transthoracic echocardiography combined with intravenous use of an echo contrast agent was useful in making a definitive diagnosis of apical hypertrophic cardiomyopathy and in characterizing the nature and full extent of the hypertrophy.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Echocardiography/methods , Thorax/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Cardiomyopathy, Hypertrophic/complications , Humans , Male , Middle Aged , Severity of Illness Index , Ventricular Dysfunction, Left/etiologyABSTRACT
We report a case of a middle-aged woman in whom a transesophageal echocardiogram showed a mass-like lesion posteriorly near the descending thoracic aorta. We were able to make a definitive diagnosis of this mass as a hiatal hernia because of a thick inner lining measuring 6-9 mm in thickness similar to the stomach mucosa, and the presence of a few microbubbles within the mass. In addition, the microbubbles increased considerably after 10 cc of agitated normal saline flush via a nasogastric tube.
