Analysis of percutaneous closure device placement when choosing an ultrasound-guided vs. a fluoroscopy-guided femoral approach. Transradial access is the access of choice in percutaneous coronary interventions, with a demonstrated benefit in mortality and bleeding when compared with transfemoral access. The latter, however, is still the access of choice in cases where large caliber introducers are…
Safety of Acetylcholine in the Cath Lab
The concepts of ischemia with non-obstructive coronary artery disease (INOCA) and myocardial infarction with non-obstructive coronary artery disease (MINOCA) have been established, widely spread, accepted, and included in the different guidelines that support our clinical practice. Among INOCA and MINOCA we find vasospastic angina (VSA) caused by epicardial vessel spasms and angina caused by microvascular…
Coronary Flow Reserve in Patients with Intermediate FFR: Should We Use This Tool to Define When to Perform Coronary Angioplasty?
Current guidelines recommend using fractional flow reserve (FFR) to guide coronary angioplasty. However, intermediate FFR values (0.75-0.80) generate uncertainty about the prognostic value of performing coronary angioplasty over optimal medical treatment. The use of coronary flow reserve (CFR) together with FFR provides further insight into coronary circulation because CFR is an index that also includes…
Passive Leg Raise: An Indispensable Maneuver in the Study of Heart Failure with Preserved Ejection Fraction
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for at least 50% of the HF population, with an increasing prevalence. Its diagnosis is based on the presence of typical symptoms and increased filling pressures, with an ejection fraction greater than 50%. In some cases—especially in the earlier stages of the disease—, laboratory and echocardiographic…
ACC 2022 | IVVE
This randomized study aimed at assessing the flu vaccine vs placebo in patients with cardiac failure. It included 5129 patients with cardiac failure randomized to receiving the flu vaccine annually for 3 years vs placebo. Primary end point included cardiovascular death, non-fatal AMI, and stroke. There were no significant differences between both groups. However, pneumonia…
E-Cigarettes: No Definitive Evidence on Their Potential Cardiovascular Effect, but Some Suggest Caution
E-cigarettes may bring about cardiac risk according to a new literature review soon to be published in J Am Coll Cardiol. The evidence on potential harm is not definitive, but some experts suggest caution in their use until there is more solid evidence. E-cigarettes have been advertised as a healthy alternative to traditional cigarettes and…
Strategies to Reduce Acute Kidney Injury in Angioplasty
The title of this article leads us to think that we will find a list of things that we can do to reduce kidney injury. However, (unfortunately) sodium bicarbonate showed no benefit over saline and n-acetylcysteine showed no benefit over a placebo for the reduction of kidney damage after coronary angioplasty. Among the protective measures…
AHA 2018 | PIONEER-HF: Sacubitril/Valsartan in Acute Decompensated Heart Failure
Treating acute decompensated heart failure patients with an angiotensin receptor inhibitor plus a neprilysin receptor inhibitor significantly reduces N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and clinical events, according to the PIONEER-HF study presented at the American Heart Association (AHA) Congress Scientific Sessions and published simultaneously in the New England Journal of Medicine (NEJM). The study…
AHA 2018 | New Dyslipidemia Guidelines Support Non-Statin Therapy and Coronary Artery Calcium Screening
While the guidelines do not recommend a specific treatment target, they suggest additional therapy in high-risk patients with LDL 70 mg/dL or higher. These new guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) start recommending ezetimibe or PCSK9 inhibition in select high-risk patients and proposing noninvasive coronary artery calcium screening…
AHA 2018 | No Benefits with Methothrexate as Anti-Inflammatory Drug
Low-dose methotrexate (a nonspecific anti-inflammatory agent used for the treatment of rheumatoid arthritis and other autoimmune disorders) did not prevent cardiovascular events in patients with a prior infarction or multivessel coronary artery disease, according to this study presented at the American Heart Association (AHA) Congress and published simultaneously in the New England Journal of Medicine…
AHA 2018 | Canakinumab Reduces Hospitalization for Cardiac Failure in Respondents
The benefit was dose-dependent reduction, regardless the presence of absence of baseline cardiac failure. Patients with prior MI and hypersensitivity C-reactive protein (hsCRP) showed dose dependent hospitalization reduction for cardiac failure with the new anti-inflammatory drug Canakinumab, according to this study presented at AHA and simultaneously published in Circulation. The difference between Canakinumab and…