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State-of-the-Art: Post-percutaneous Coronary Intervention Pharmacotherapy

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Prof. Dr. Kyung W. Park

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Guest Editor

Office of Innovation and Quality, Seoul National University Hospital, Seoul, Korea

Special Issue Information

Dear Colleagues,

The number of percutaneous coronary intervention (PCI) procedures is rapidly expanding worldwide, and the clinical/procedural severity of PCI cases are escalating. As PCI is performed more on patients with an increased burden of cardiovascular risk factors, the importance of optimal post-PCI pharmacotherapy is also growing. Recent results from many clinical trials have led to numerous updates and changes to the guidelines. However, the guidelines cannot be uniformly applied to all of the complex clinical situations that clinicians meet, and there are still unmet questions that need to be answered.

Therefore, this Special Issue of Journal of Clinical Medicine will cover various newly emerging concepts and important aspects of pharmacological treatment for patients who have received PCI, which may contribute to the improvement of patient care. Relevant study topics include but are not limited to antiplatelet therapy, lipid-lowering therapy, and various post-PCI pharmacotherapy strategies.

For example, studies focusing on the following aspects are welcomed to this Special Issue.

Personalized antiplatelet therapy for patients who received PCI

1) Escalation/de-escalation of potent antiplatelet agents.

2) Biomarker studies for the adequate regimen of antiplatelet agents.

Antiplatelet agent treatment for high bleeding risk/high ischemic risk patients who received PCI.
Personalized lipid-lowering therapy for patients who received PCI

3) Statin and PCSK9 inhibitors

4) Lp(a)- or ApoB-targeting therapies

Other adjunctive treatments for post-PCI patients, such as beta-blocker treatment, RAAS blockade treatment.
Optimal risk factor control (i.e., diabetes, hypertension, dyslipidemia, renal impairment, etc.) in post-PCI patients.

Prof. Dr. Kyung W. Park
Guest Editor

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Research

14 pages, 1127 KiB

Open AccessArticle

Effects of Monotherapy with Clopidogrel vs. Aspirin on Vascular Function and Hemostatic Measurements in Patients with Coronary Artery Disease: The Prospective, Crossover I-LOVE-MONO Trial

by Hyun-Woong Park, Min-Gyu Kang, Jong-Hwa Ahn, Jae-Seok Bae, Udaya S. Tantry, Paul A. Gurbel and Young-Hoon Jeong

J. Clin. Med. 2021, 10(12), 2720; https://doi.org/10.3390/jcm10122720 - 20 Jun 2021

Cited by 6 | Viewed by 3971

Abstract

Objectives: To evaluate the effect of clopidogrel vs. aspirin monotherapy on vascular function and hemostatic measurement. Background: Monotherapy with P2Y₁₂ receptor inhibitor vs. aspirin can be a useful alterative to optimize clinical efficacy and safety in high-risk patients with coronary artery disease (CAD). Methods: We performed a randomized, open-label, two-period crossover study in stented patients receiving at least 6-month of dual antiplatelet therapy (DAPT). Thirty CAD patients with moderate-to-high ischemic risk were randomly assigned to receive either 75 mg of clopidogrel or 100 mg of aspirin daily for 4 weeks, and were crossed over to the other strategy for 4 weeks. Vascular function was evaluated with reactive hyperemia-peripheral arterial tonometry (RH-PAT) and brachial-ankle pulse wave velocity (baPWV). Hemostatic profiles were measured with VerifyNow and thromboelastography (TEG). The primary endpoint was the reactive hyperemia index (RHI) during clopidogrel or aspirin monotherapy. Results: Clopidogrel vs. aspirin monotherapy was associated with better endothelial function (RHI: 2.11 ± 0.77% vs. 1.87 ± 0.72%, p = 0.045), lower platelet reactivity (130 ± 64 vs. 214 ± 50 P2Y12 reaction unit [PRU], p < 0.001) and prolonged reaction time (TEG R: 5.5 ± 1.2 vs. 5.1 ± 1.1 min, p = 0.037). In multivariate analysis, normal endothelial function (RHI ≥ 2.1) was significantly associated with clot kinetics (TEG angle ≤ 68 degree) and ‘PRU ≤ 132’. ‘PRU ≤ 132’ was achieved in 46.2% vs. 3.8% during clopidogrel administration vs. aspirin monotherapy (odds ratio 21.4, 95% confidence interval 2.7 to 170.1, p < 0.001). Conclusions: In CAD patients, clopidogrel vs. aspirin monotherapy was associated with better endothelial function, greater platelet inhibition and lower coagulation activity, suggesting pleiotropic effects of clopidogrel on endothelial function and hemostatic profiles. Full article

(This article belongs to the Special Issue State-of-the-Art: Post-percutaneous Coronary Intervention Pharmacotherapy)

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17 pages, 1971 KiB

Open AccessArticle

Impact of Intensive Glucose Control in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention: 3-Year Clinical Outcomes

by Jiesuck Park, Jung-Kyu Han, Mineok Chang, You-Jeong Ki, Jeehoon Kang, Han-Mo Yang, Hyun-Jai Cho, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo and Hyo-Soo Kim

J. Clin. Med. 2020, 9(8), 2464; https://doi.org/10.3390/jcm9082464 - 1 Aug 2020

Cited by 4 | Viewed by 2703

Abstract

We investigated whether intensive glucose control after percutaneous coronary intervention (PCI) improves clinical outcomes in diabetic patients. From the Grand-DES registry, we analyzed 2576 diabetic patients (median age 66 years, male 65.6%) who underwent PCI and had at least 2 records of HbA1c during the follow-up. Patients were categorized according to the mean HbA1c (≥7% or <7%). Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and any revascularization. During a median follow-up of 33.6 months, MACE occurred in 335 (13.0%) patients. Intensive glucose control with follow-up mean HbA1c < 7.0% (42.2%; n = 1087) was not associated with lower risk of MACE, compared to control with mean HbA1c ≥ 7.0% (adjusted hazard ratio [aHR] [95% confidence interval] 1.06 [0.82–1.37], p = 0.672). In subgroup analysis, patients with sustained HbA1c of <7.0% throughout the follow-up were not associated with a lower risk of MACE compared to those with sustained HbA1c of ≥7.0% (aHR 1.15 [0.71–1.89], p = 0.566). More intensive glucose control with mean HbA1c ≤ 6.5% was not associated with lower risk of MACE, compared to loose control with a mean HbA1c ≥ 8.0% (aHR 1.15 [0.71–1.86], p = 0.583). Intensive glucose control after PCI was not associated with better clinical outcomes in diabetic patients undergoing PCI than lenient control. Full article

(This article belongs to the Special Issue State-of-the-Art: Post-percutaneous Coronary Intervention Pharmacotherapy)

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