PATRICIA OLIVEIRA GUIMARAES
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- REPLY: Elimination of Aspirin From PCI Pharmacotherapy(2021) LEMOS, Pedro A.; KOGAME, Norihiro; GUIMARAES, Patricia O.; MODOLO, Rodrigo; SERRUYS, Patrick W.
- Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study(2021) ABIZAID, Alexandre; CAMPOS, Carlos M.; GUIMARAES, Patricia O.; JR, Jose de Ribamar Costa; FALCAO, Breno A. A.; MANGIONE, Fernanda; CAIXETA, Adriano; LEMOS, Pedro A.; BRITO, Fabio S. de; CAVALCANTE, Ricardo; BEZERRA, Cristiano Guedes; CORTES, Leandro; RIBEIRO, Henrique B.; SOUZA, Francis R. de; HUEMER, Natassja; VAL, Renata M. do; CARAMELLI, Bruno; CALDERARO, Daniela; LIMA, Felipe G.; HAJJAR, Ludhmila A.; MEHRAN, Roxana; KALIL FILHO, RobertoObjectives We aimed to explore angiographic patterns and in-hospital outcomes of patients with concomitant coronavirus disease-19 (COVID-19) and myocardial infarction (MI). Background Patients with COVID-19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID-19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID-19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1-10) days. A total of 83 (54.6%) patients presented with ST-elevation MI. The median angiographic Syntax score was 16 (9.0-25.3) and 69.0% had multi-vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in-hospital mortality was 23.7%. ST-segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30-5.80 and HR 3.73, 95%CI 1.61-8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID-19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in-hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
conferenceObject A 30-Day Pooled Analysis of Acetyl Salicylic Elimination Trials (ASET) in Brazil and Japan: Synergy Stent with Prasugrel Monotherapy Without Aspirin(2023) ONUMA, Yoshinobu; MASUDA, Shinichiro; MURAMATSU, Takashi; ISHIBASHI, Yuki; KOZUMA, Ken; KAWASHIMA, Hideyuki; NAKAZAWA, Gaku; TAKAHASHI, Kuniaki; TANABE, Kengo; KOGAME, Norihiro; NAKAMURA, Masato; ASANO, Taku; OKAMURA, Takayuki; MIYAZAKI, Yosuke; TATEISHI, Hiroki; OZAKI, Yukio; NAKATANI, Shimpei; KATAGIRI, Yuki; MORINO, Yoshihiro; NINOMIYA, Kai; KAGEYAMA, Shigetaka; KOTOKU, Nozomi; GUIMARAES, Patricia O.; LEMOS, Pedro A.; SERRUYS, Patrick W.- Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD The ASET Pilot Study(2020) KOGAME, Norihiro; GUIMARAES, Patricia O.; MODOLO, Rodrigo; MARTINO, Fernando De; TINOCO, Joao; RIBEIRO, Expedito E.; KAWASHIMA, Hideyuki; ONO, Masafumi; HARA, Hironori; WANG, Rutao; CAVALCANTE, Rafael; MOULIN, Bruno; FALCAO, Breno A. A.; LEITE, Rogerio S.; SAMPAIO, Fernanda Barbosa de Almeida; MORAIS, Gustavo R.; MEIRELES, George C.; CAMPOS, Carlos M.; ONUMA, Yoshinobu; SERRUYS, Patrick W.; LEMOS, Pedro A.OBJECTIVES The aim of this study was to evaluate the hypothesis that prasugrel monotherapy following successful everolimus-eluting stent implantation is feasible and safe in patients with stable coronary artery disease (CAD). BACKGROUND Recent studies have suggested that short dual-antiplatelet therapy strategies may provide an adequate balance between ischemic and bleeding risks. However, the complete omission of aspirin immediately after percutaneous coronary intervention (PCI) has not been tested so far. METHODS The study was a multicenter, single-arm, open-label trial with a stopping rule based on the occurrence of definite stent thrombosis (if >3, trial enrollment would be terminated). Patients undergoing successful everolimus-eluting stent implantation for stable CAD with SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores <23 were included. All participants were on standard dual-antiplatelet therapy at the time of index PCI. Aspirin was discontinued on the day of the index procedure but given prior to the procedure; prasugrel was administered in the catheterization laboratory immediately after the successful procedure, and aspirin-free prasugrel became the therapy regimen from that moment. Patients were treated solely with prasugrel for 3 months. The primary ischemic endpoint was the composite of cardiac death, spontaneous target vessel myocardial infarction, or definite stent thrombosis, and the primary bleeding endpoint was Bleeding Academic Research Consortium types 3 and 5 bleeding up to 3 months. RESULTS From February 22, 2018, to May 7, 2019, 201 patients were enrolled. All patients underwent PCI for stable CAD. Overall, 98.5% of patients were adherent to prasugrel at 3-month follow-up. The primary ischemic and bleeding endpoints occurred in 1 patient (0.5%). No stent thrombosis events occurred. CONCLUSIONS Aspirin-free prasugrel monotherapy following successful everolimus-eluting stent implantation demonstrated feasibility and safety without any stent thrombosis in selected low-risk patients with stable CAD. These findings may help underpin larger randomized controlled studies to evaluate the aspirin-free strategy compared with traditional dual-antiplatelet therapy following PCI. (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.