- Email: [email protected]
Pharmacological Treatment
WEDNESDAY 4/25/07 12:30 –1:30
O R A L
Pharmacological Treatment Sheraton Grande Walkerhill Hotel Room B1-1 Wednesday, April 25, 2007 12:30 PM–1:30 PM
A B S T R A C T S
(Abstract no. 13) Sheraton Grande Walkerhill Hotel Symposium Arena Thursday, April 26, 2007 9:30 AM–10:30 AM (Abstract no. 14)
Age (years) Sex Diabetes Hypertension Acute coronary syndromes Multivessel disease B2 or C type Left main disease Bifurcation lesion In-stent restenosis Chronic total occlusion Number of stents used (number) Total stents length per lesion (mm)
PM
(Room B1-1)
Dual therapy (n ⴝ 101)
Triple therapy (n ⴝ 54)
P
68 (67%) 43 (43%) 59 (58%) 61 (60%) 55 (54%) 66 (65%) 4 (4%) 11 (11%) 10 (10%) 8 (8%) 1.32 ⫾ 0.52
41 (76%) 14 (26%) 25 (46%) 28 (52%) 37 (68%) 45 (83%) 16 (30%) 13 (26%) 6 (11%) 6 (11%) 1.67 ⫾ 0.73
0.264 0.041 0.149 0.305 0.043 0.018 ⬍0.001 0.015 0.829 0.509 0.002
34.21 ⫾ 17.60
44.87 ⫾ 22.07
0.003
Conclusion: Compared with the dual antiplatelet regimen, triple antiplatelet therapy significantly enhanced platelet inhibition by clopidogrel but not aspirin. Therefore, triple antiplatelet therapy may be more effective in patients undergoing DES implantation for inhibition of platelet reactivity and subsequent thrombotic events.
AS-14
AS-13 Triple Antiplatelet Therapy Enhanced a Platelet Inhibition by Clopidogrel More Than Dual Antiplatelet Therapy after DrugEluting Stent Implantation: Insights from the Clopidogrel and Aspirin Resistance Evaluation in Patients undergoing Coronary Revascularization (CARE-PCR) Registry. S.W. Park, D.W. Park, J.H. Kim, H. Ko, Y.H. Kim, C.W. Lee, M.K. Hong, J.J. Kim, S.J. Park. Asian Medical Center, Seoul, Republic of Korea. Background: Considerable thrombotic events in patients treated with drug-eluting stents (DES) and dual antiplatelet therapy with aspirin and clopidogrel remain an unresolved issue. Triple antiplatelet therapy with aspirin, clopidogrel, and cilostazol might have influence on responsiveness to antiplatelet agent in patients undergoing DES implantation. Methods: We determined aspirin and clopidogrel responsiveness of 155 consecutive patients who underwent DES implantation using the Rapid Platelet Function Assay. Aspirin and clopidogrel responsiveness were represented as aspirin reaction units (ARU) or percent platelet inhibition (%), respectively. Patients treated with DES were divided into dual antiplatelet therapy (n ⫽ 101) and triple antiplatelet therapy (n ⫽ 54). Results: Baseline clinical characteristics were similar between the 2 groups. Triple therapy was used in more complex lesion subsets than dual therapy (Table). Number of stents used and total stent length were significantly larger in the triple-therapy group. There was no difference in response to aspirin between groups (433.3 ⫾ 53.3 in the dual group vs 422.5 ⫾ 48.2 in triple group, p ⫽ 0.214). However, platelet inhibition by clopidogrel was significantly higher in the triple group (17.8 ⫾ 20.7% in dual group vs 30.6 ⫾ 19.2% in triple group, p ⬍0.001).
8F
Effects of Telmisartan and Valsartan on Late Lumen Loss and Inflammatory Markers after Sirolimus-Eluting Stent Implantation in Hypertensive Patients. S.J. Hong, W.J. Shim, J.I. Choi, H.J. Joo, J.S. Kim, S.Y. Shin, S.H. Shin, D.S. Lim. Korea University Anam Hospital, Seoul, Republic of Korea. Background: The effect of telmisartan, which has selective peroxisome proliferator activated receptor (PPAR)-␥ activity, on the reduction of late lumen loss has not been verified. We compared the effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent (SES) implantation in hypertensive patients. Methods: This was a prospective, randomized, single-blind, 8-month follow-up study including hypertensive patients with significant coronary artery stenosis (previously untreated de novo lesions with ⬎70% diameter stenosis) assigned to the Telmisartan group (n ⫽ 45) and the Valsartan group (n ⫽ 46). Results: Risk factors, such as diabetes, hyperlipidemia, smoking, and obesity, were similar in both groups. After 8-month follow-up, only the Telmisartan group showed significant decreases in interleukin-6 and tumor necrosis factor-␣. The decreases from baseline in total and low density lipid cholesterol concentrations were significantly greater in the Telmisartan group. The increase in adiponectin concentrations from baseline was significantly greater in the Telmisartan group compared with the Valsartan group (2.06 ⫾ 2.73 vs 0.46 ⫾ 2.08 g/mL, p ⬍0.05, respectively). Moreover, late lumen loss was significantly lower in the Telmisartan group compared with the Valsartan group (0.16 ⫾ 0.39 vs 0.45 ⫾ 0.60 mm, p ⫽ 0.004, respectively). Major adverse cardiac events were similar in the 2 groups (6.7% [n ⫽ 3] in the Telmisartan group and 8.7% [n ⫽ 4] in the Valsartan group; p ⫽ 0.51). Conclusion: Telmisartan, compared with valsartan, was associated with significant decrease in the late lumen loss and inflammatory markers after SES implantation in hypertensive patients with significant coronary lesions.
The American Journal of Cardiology姞 APRIL 25-27 2007 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
O R A L
Pharmacological Treatment Sheraton Grande Walkerhill Hotel Room B1-1 Wednesday, April 25, 2007 12:30 PM–1:30 PM
A B S T R A C T S
(Abstract no. 13) Sheraton Grande Walkerhill Hotel Symposium Arena Thursday, April 26, 2007 9:30 AM–10:30 AM (Abstract no. 14)
Age (years) Sex Diabetes Hypertension Acute coronary syndromes Multivessel disease B2 or C type Left main disease Bifurcation lesion In-stent restenosis Chronic total occlusion Number of stents used (number) Total stents length per lesion (mm)
PM
(Room B1-1)
Dual therapy (n ⴝ 101)
Triple therapy (n ⴝ 54)
P
68 (67%) 43 (43%) 59 (58%) 61 (60%) 55 (54%) 66 (65%) 4 (4%) 11 (11%) 10 (10%) 8 (8%) 1.32 ⫾ 0.52
41 (76%) 14 (26%) 25 (46%) 28 (52%) 37 (68%) 45 (83%) 16 (30%) 13 (26%) 6 (11%) 6 (11%) 1.67 ⫾ 0.73
0.264 0.041 0.149 0.305 0.043 0.018 ⬍0.001 0.015 0.829 0.509 0.002
34.21 ⫾ 17.60
44.87 ⫾ 22.07
0.003
Conclusion: Compared with the dual antiplatelet regimen, triple antiplatelet therapy significantly enhanced platelet inhibition by clopidogrel but not aspirin. Therefore, triple antiplatelet therapy may be more effective in patients undergoing DES implantation for inhibition of platelet reactivity and subsequent thrombotic events.
AS-14
AS-13 Triple Antiplatelet Therapy Enhanced a Platelet Inhibition by Clopidogrel More Than Dual Antiplatelet Therapy after DrugEluting Stent Implantation: Insights from the Clopidogrel and Aspirin Resistance Evaluation in Patients undergoing Coronary Revascularization (CARE-PCR) Registry. S.W. Park, D.W. Park, J.H. Kim, H. Ko, Y.H. Kim, C.W. Lee, M.K. Hong, J.J. Kim, S.J. Park. Asian Medical Center, Seoul, Republic of Korea. Background: Considerable thrombotic events in patients treated with drug-eluting stents (DES) and dual antiplatelet therapy with aspirin and clopidogrel remain an unresolved issue. Triple antiplatelet therapy with aspirin, clopidogrel, and cilostazol might have influence on responsiveness to antiplatelet agent in patients undergoing DES implantation. Methods: We determined aspirin and clopidogrel responsiveness of 155 consecutive patients who underwent DES implantation using the Rapid Platelet Function Assay. Aspirin and clopidogrel responsiveness were represented as aspirin reaction units (ARU) or percent platelet inhibition (%), respectively. Patients treated with DES were divided into dual antiplatelet therapy (n ⫽ 101) and triple antiplatelet therapy (n ⫽ 54). Results: Baseline clinical characteristics were similar between the 2 groups. Triple therapy was used in more complex lesion subsets than dual therapy (Table). Number of stents used and total stent length were significantly larger in the triple-therapy group. There was no difference in response to aspirin between groups (433.3 ⫾ 53.3 in the dual group vs 422.5 ⫾ 48.2 in triple group, p ⫽ 0.214). However, platelet inhibition by clopidogrel was significantly higher in the triple group (17.8 ⫾ 20.7% in dual group vs 30.6 ⫾ 19.2% in triple group, p ⬍0.001).
8F
Effects of Telmisartan and Valsartan on Late Lumen Loss and Inflammatory Markers after Sirolimus-Eluting Stent Implantation in Hypertensive Patients. S.J. Hong, W.J. Shim, J.I. Choi, H.J. Joo, J.S. Kim, S.Y. Shin, S.H. Shin, D.S. Lim. Korea University Anam Hospital, Seoul, Republic of Korea. Background: The effect of telmisartan, which has selective peroxisome proliferator activated receptor (PPAR)-␥ activity, on the reduction of late lumen loss has not been verified. We compared the effects of telmisartan and valsartan on late lumen loss and inflammatory markers after sirolimus-eluting stent (SES) implantation in hypertensive patients. Methods: This was a prospective, randomized, single-blind, 8-month follow-up study including hypertensive patients with significant coronary artery stenosis (previously untreated de novo lesions with ⬎70% diameter stenosis) assigned to the Telmisartan group (n ⫽ 45) and the Valsartan group (n ⫽ 46). Results: Risk factors, such as diabetes, hyperlipidemia, smoking, and obesity, were similar in both groups. After 8-month follow-up, only the Telmisartan group showed significant decreases in interleukin-6 and tumor necrosis factor-␣. The decreases from baseline in total and low density lipid cholesterol concentrations were significantly greater in the Telmisartan group. The increase in adiponectin concentrations from baseline was significantly greater in the Telmisartan group compared with the Valsartan group (2.06 ⫾ 2.73 vs 0.46 ⫾ 2.08 g/mL, p ⬍0.05, respectively). Moreover, late lumen loss was significantly lower in the Telmisartan group compared with the Valsartan group (0.16 ⫾ 0.39 vs 0.45 ⫾ 0.60 mm, p ⫽ 0.004, respectively). Major adverse cardiac events were similar in the 2 groups (6.7% [n ⫽ 3] in the Telmisartan group and 8.7% [n ⫽ 4] in the Valsartan group; p ⫽ 0.51). Conclusion: Telmisartan, compared with valsartan, was associated with significant decrease in the late lumen loss and inflammatory markers after SES implantation in hypertensive patients with significant coronary lesions.
The American Journal of Cardiology姞 APRIL 25-27 2007 ANGIOPLASTY SUMMIT ABSTRACTS/Oral