STEMI vs. NSTEMI vs. STABLE CAD - ACC
[Pages:18]49th Annual New York Cardiovascular Symposium
STEMI vs. NSTEMI vs. STABLE CAD
Challenging Cases and Antithrombotic Approaches
December 9, 2016
Jonathan L. Halperin, M.D.
The Cardiovascular Institute Mount Sinai Medical Center
Disclosure
Relationships with Industry
Consultant to the following companies involved in developing antithrombotic drugs:
? AstraZeneca ? Bayer HealthCare ? Boehringer Ingelheim ? Bristol-Myers Squibb ? Daiichi Sankyo ? Janssen Ortho McNeil ? Johnson & Johnson ? Pfizer
Case 1
? 79 year-old woman with hypertension, hypothyroidism, and palpitation presented with sudden onset of chest pain, palpitation and dyspnea.
? ECG: AF with RVR (140-160 bpm) and ST-segment depressions; troponin 0.41 ng/ml (mildly elevated). Other lab values normal.
? Rate controlled with metoprolol, given aspirin and heparin and transferred for cardiac catheterization
? Angiography: 3-vessel CAD.
? Procedure: PCI with rotational atherectomy + DES of proximal LAD and DES of Cfx into OM1.
n = 2,100 700 subjects per treatment strategy
PIONEER AF-PCI
Trial Design
Rivaroxaban, 15 mg daily + clopidogrel or P2Y12 inhibitor
PCI (with stent)
AF
Rivaroxaban 2.5 mg b.i.d. + DAPT
Rivaroxaban 15 mg daily + Low-dose ASA
Randomization
up to 72 hours after sheath removal
VKA (INR: 2.0 to 3.0) + DAPT
Intended DAPT duration 1, 6, or 12 months
Gibson CM, et al. Am Heart J 2014; 169: 472.
VKA (INR: 2.0 to 3.0) + low-dose ASA
End of treatment 12 months
Primary endpoint Clinically relevant bleeding
First Occurrence of Clinically Significant Bleeding PIONEER AF-PCI
TIMI Major, TIMI Minor, or Bleeding Requiring Medical Attention (%)
26.7%
VKVVAKKA+A+D+ADDPAATPPTT
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