Late Presenters with ST-Elevation Myocardial Infarction: A Call to Action.

The emphasis on timely coronary reperfusion in the setting of ST-segment elevation Myocardial Infarction (STEMI) comes from older studies suggesting a significant reduction in mortality among patients treated with fibrinolytic therapy during the first hours after onset of symptoms and a progressive increase in fatal events in those presenting later [...].

Acute coronary syndrome and renal impairment: a systematic review.

BACKGROUND: Coronary artery disease (CAD) and chronic kidney disease (CKD) may reciprocally influence each other. Patients with CAD and CKD have an increased risk of both ischemic and hemorrhagic events. METHODS: In the present review, we summarize the existing literature focusing on the relationship between kidney dysfunction and acute coronary syndromes (ACS) in terms of risk factors, complications, and prognosis. We discuss also about the best evidence-based strategies to prevent deterioration of renal function in patients with CAD. RESULTS: Patients with CKD less frequently receive an invasive management (percutaneous or surgical revascularization) and potent antithrombotic drugs. Nevertheless, recent evidence suggests they would benefit from a selective invasive management, especially in case of ACS. CONCLUSION: Patients with CKD and CAD represent a challenging population, more randomized controlled trials and meta-analyses are needed to better define the best therapeutic strategy during an ACS episode.

Antithrombotic Strategies in Patients with Atrial Fibrillation and Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.

Patients with atrial fibrillation (AF) are at increased risk for coronary artery disease (CAD). After percutaneous coronary intervention (PCI), the antithrombotic therapy consists of a combination of anticoagulant and antiplatelet agents to reduce the ischemic and thromboembolic risk, at the cost of increased bleeding events. In the past few years, several randomized clinical trials involving over 12,000 patients have been conducted to compare the safety of vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs) in association with a single- or double-antiplatelet agent, in the so-called dual- (DAT) or triple-antithrombotic therapy (TAT). These studies and several meta-analyses showed a consistent benefit for reducing bleeding events of DAT over TAT and of DOAC over VKA, without concerns about ischemic endpoints, except for a trend for increased stent thrombosis risk. The present paper examines current international guidelines' recommendations and reviews clinical trials, meta-analyses, and observational studies conducted on AF patients treated with DAT or TAT after PCI for acute coronary syndromes.