Percutaneous Coronary Intervention
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the cardiovascular analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Objective of the analysis - page 3
- Datamonitor insight into the Percutaneous Coronary Intervention market - page 4
- Contributing experts - page 5
- CHAPTER 2 PCI DEFINITIONS AND INDICATIONS - page 7
- Percutaneous coronary interventions - page 7
- Physical intervention: - page 8
- Adjunctive pharmacological treatment: - page 8
- Candidates for PCI - page 9
- Treatment goals for PCI patients - page 10
- Pathophysiology of acute coronary syndromes - page 10
- Coronary artery disease and atherosclerosis - page 10
- Vulnerable plaque - page 11
- Histopathology of atherosclerotic lesions - page 12
- Remodeling and role of coronary artery inflammation - page 14
- Indications for PCI - page 15
- Unstable angina (UA) - page 15
- Variant angina - page 16
- ST segment elevated myocardial infarction (STEMI) - page 16
- Non-ST segment elevated myocardial infarction (NSTEMI) - page 17
- New definition of NSTEMI - page 17
- Unstable angina (UA) - page 15
- Primary PCI versus Elective PCI - page 18
- Percutaneous coronary interventions - page 7
- CHAPTER 3 DIAGNOSIS OF ACS AND REFERRAL FOR PCI - page 20
- Symptoms - page 20
- Initial and final diagnosis - page 20
- Diagnosis and investigation in ACS - page 21
- Physical examination and chest pain differential - page 21
- Clinical tests in primary investigation - page 22
- ECG and ECG stress testing - page 22
- Monitoring cardiac biomarkers - page 24
- Cardiac troponins - page 24
- Creatine Kinase (CK) - page 25
- Myoglobin - page 26
- C-reactive protein (CRP) - page 26
- Neurohormonal activation markers - page 26
- Novel biomarkers - page 27
- Multimarker approach - page 27
- Risk stratification - page 27
- Classification according to diagnosis - page 29
- Factors dictating referral for PCI procedure - page 29
- STEMI patients - page 30
- NSTEMI patients - page 30
- UA Patients - page 31
- Referral for PCI following angiography - page 31
- Guidelines - page 33
- Recommendations for treatment of NSTEMI and UA - page 33
- Recommendations for treatment of STEMI - page 34
- Specific PCI guidelines - page 35
- CHAPTER 4 PCI MARKET DYNAMICS - page 36
- ACS epidemiology specifics and limitations - page 36
- Prevalence and incidence of ACS in the seven major markets - page 37
- Incidence of STEMI - page 37
- Opinion leader epidemiology estimates - page 38
- Incidence of UA and NSTEMI - page 38
- Change in troponin definition explains rise in NSTEMI cases - page 39
- The PCI market - page 40
- PCI procedural rates - page 40
- CHAPTER 5 PCI VERSUS THROMBOLYSIS - page 44
- Thrombolysis versus primary PCI - page 44
- Evidence from registries - page 45
- The TIME factor in reperfusion - page 46
- Primary PCI is less time dependent than thrombolysis alone - page 46
- Randomized clinical trials show PCI to be the optimum approach - page 47
- Facilitated PCI - page 47
- Current thinking on facilitated PCI - page 48
- Facilitated PCI with GPIIb/IIIa inhibitors - page 48
- Facilitated PCI with thrombolytics - page 49
- GPIIb/IIIa and thrombolytic combination adjunctive therapy - page 50
- Clinical trials in GPIIb/IIIa facilitated PCI - page 50
- TIMI-14 - page 50
- SPEED/GUSTO - page 50
- Controversies from ongoing clinical trials - page 52
- ASSENT-4 - page 52
- Thrombolysis versus primary PCI - page 44
- CHAPTER 6 ADJUNCTIVE DRUG THERAPY - page 54
- Drug classes used in combination with PCI - page 54
- Addressing co-morbidities - page 54
- Anti-ischemic agents - page 54
- Nitrates - page 54
- Betablockers - page 56
- Antithrombotics - page 58
- Anticoagulants - page 59
- Heparins - page 59
- Antiplatelet agents - page 64
- COX-1 inhibitors (aspirin) - page 64
- ADP receptor antagonists - page 66
- Exceptions to the rule - page 69
- Clopidogrel versus ticlopidine - page 69
- Novel ADP antagonists - page 70
- Prasugrel - page 70
- GPIIb/IIIa receptor inhibitors - page 71
- Use of GPIIb/IIIa inhibitors - page 75
- Anticoagulants - page 59
- Drug classes used in combination with PCI - page 54
- CHAPTER 7 STENTS - page 77
- Overview - page 77
- Bare metal stents - page 78
- Drug-eluting stents - page 79
- In-stent restenosis: the man-made condition - page 80
- Branded drug eluting stents - page 83
- Cypher (sirolimus) - page 83
- Taxus (paclitaxel) - page 84
- Next generation drug eluting stents - page 85
- Xience (everolimus) - page 86
- Endeavor (zotarolimus) - page 87
- Overview - page 77
- APPENDIX - page 89
- Bibliography - page 89
- Disclaimer - page 91
- List of Tables
- Table 1: Types of chest pain - page 22
- Table 2: Risk stratification summary for ACS, 2006 - page 29
- Table 3: Incidence of ST-segment elevation myocardial infarction (000s) - page 38
- Table 4: Incidence of unstable angina and non-ST segment elevation myocardial infarction (000s), 2005-2015 - page 39
- List of Figures
- Figure 1: Development and progression of atherosclerosis - page 11
- Figure 2: Pathogenesis of a plaque leading to rupture - page 12
- Figure 3: Basic diagnostic flow in ACS - page 21
- Figure 4: Percentage of all ACS patients receiving Diagnostic Angiography test, then PCI and then Stenting, 2007. - page 32
- Figure 5: The 10 leading causes of death in high-income countries (%), 2005 projections - page 36
- Figure 6: Number of PCI procedures in the US, 1986- 2003 - page 41
- Figure 7: Percentage of PCI patients by indication in Europe, 2008 - page 42
- Figure 8: Percentage of ACS patients receiving thrombolysis, PCI, or both, in the 5EU, 2007. - page 46
- Figure 9: Percentage of ACS patients receiving thrombolysis, PCI, or both, in the 5EU, 2007. - page 56
- Figure 10: Percentage of ACS and PCI patients receiving betablockers (BBs), in in the 5EU, 2007. - page 58
- Figure 11: Percentage of ACS and PCI patients receiving UFH, in the 5EU, 2007. - page 62
- Figure 12: Percentage of ACS and PCI patients receiving LMWH, in the 5EU, 2007. - page 63
- Figure 13: Percentage of ACS and PCI patients receiving COX-1 inhibitors, in the 5EU, 2007. - page 66
- Figure 14: Percentage of ACS and PCI patients receiving ADP antagonists in the 5EU, 2007. - page 68
- Figure 15: Percentage of PCI patients receiving ADP antagonists split by prescribed indication, in the 5EU, 2007. - page 69
- Figure 16: Percentage of PCI patients receiving GPIIb/IIIa antagonists, split by indication, in the 5EU, 2007. - page 72
- Figure 17: Antiplatelet therapy in ACS - page 73
- Figure 18: Percentage of ACS and PCI patients receiving GPIIb/IIIa antagonists, in the 5EU, 2007. - page 75
- Figure 19: Percentage stent usage, split by stent type, in Europe, 2007 - page 82
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