Abstract 4142264: De-escalation of Dual Antiplatelet Therapy by Changing Ticagrelor to Clopidogrel Versus Ticagrelor Monotherapy in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Circulation, Volume 150, Issue Suppl_1, Page A4142264-A4142264, November 12, 2024. Background:Two de-escalation options of dual antiplatelet therapy (DAPT) have been proposed to mitigate bleeding risk in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), including maintaining DAPT but reducing its intensity by changing potent P2Y12 inhibitor (P2Y12i) to clopidogrel or discontinuation of DAPT by using P2Y12i monotherapy. Our study aims to evaluate the use of de-escalation therapies after discharge in AMI pts undergoing PCI and compare the clinical outcomes of the two de-escalation options.Methods and Results:In the Taiwan National Health Insurance Research Database, we included adult pts (≥ 18 yrs) who received PCI for AMI and survived to discharge with DAPT. Pts who need oral anticoagulant were excluded. From 2011 to 2021, 58989 pts (mean age 61.9±13.2 yrs, male 81.4%) were included. After 2016, >70% pts were treated with aspirin plus ticagrelor (A+T) at discharge. In A+T users (n=28698), de-escalation for any reason occurred in 52.2% during follow-up. Among de-escalation therapy, aspirin plus clopidogrel (A+C, 55.8%) and ticagrelor monotherapy (T mono, 15.5%) were most commonly used in the first 6 mo. The mean duration from discharge to de-escalation to T mono vs. A+C was 52.5±69.3 vs. 68.4±70.7 days (p

Read More
Novembre 2024

Abstract 4143019: Fetuses with Congenital Heart Disease and Placental Malperfusion Have Adverse Outcomes and De Novo Variants in Key Placental Developmental Pathways

Circulation, Volume 150, Issue Suppl_1, Page A4143019-A4143019, November 12, 2024. Background:Placental malperfusion (PMP), and perturbation of shared developmental pathways between the fetal heart and placenta, may play a role in the development and outcomes of congenital heart disease (CHD). We hypothesize that genomic variation in pathways involved in vascular or placental development underlie PMP in CHD, which in turn impacts outcomes.Methods:Fetuses were diagnosed prenatally with structural CHD in our Fetal Heart Program. Maternal characteristics, neonatal biometrics, genomic diagnoses, and outcomes data were reviewed. Placentas with PMP met pathological criteria according to the Amsterdam Placental Workshop classification for maternal or fetal vascular malperfusion, or placental weight

Read More
Novembre 2024