André Franci

SBC guidelines on unstable angina and non-ST-elevation myocardial infarction: executive summary.

Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work.

DRUG INTERACTION BETWEEN CLOPIDOGREL AND RANITIDINE OR OMEPRAZOLE IN PATIENTS WITH CORONARY HEART DISEASE: A DOUBLE-BLIND, DOUBLE-DUMMY, RANDOMIZED COMPARATIVE STUDY

In patients taking dual antiplatelet therapy with acetylsalycilic acid (ASA) and clopidogrel, proton-pump inhibitors are often utilized for gastrointestinal (GI) bleeding prophylaxis. However, this class of medication has been associated with reduction of the antiplatelet potency of clopidogrel. The

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.

PLATELET AGGREGABILITY, COAGULATION, FIBRINOLYSIS AND INFLAMMATION IN PATIENTS WITH CORONARY ARTERY DISEASE AND PREVIOUS CEREBROVASCULAR ISCHEMIC EVENT

Background: Approximately 17% of pts with coronary artery disease (CAD) have previous ischemic stroke or transitory ischemic attack. (IS/TIA). This is a high risk subgroup for ischemic and bleeding events. The role of platelet aggregability, coagulation, endogenous fibrinolysis and inflammation in