1- High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things
Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions.
Transradial access is here to stay; that much has been clear for some time now. However, some operators still resist change and the systematic use of this technique shows great geographical dispersion. Some of its limitations are a difficulty to obtain access and the somewhat frequent occurrence of radial artery occlusion after the procedure. This study assessed a very simple resource to avoid artery occlusion: an injection of nitroglycerin at the puncture site.
The wait is finally over: the high blood pressure guidelines that have been in the works for the past 3 years saw the light of day at the American Heart Association (AHA) 2017 Scientific Sessions.
Successful rechanneling of a chronic total occlusion (currently around 90%) leads to significant improvement in quality of life and symptom frequency in patients with stable chronic angina compared with optimal medical treatment alone.
5- Ten Commandments of the European Hypertension Guidelines: Several “Sins Allowed” Compared with American Guidelines
These new hypertension guidelines (which were as long-awaited as the American ones, back then) finally emerged in Barcelona, at the European Society of Hypertension (ESH) Congress. The document was issued jointly with the European Society of Cardiology (ESC).
Aspirin failed to reach the primary endpoint in a population that was at risk of experiencing cardiovascular disease. However, something that a short time ago seemed obvious could not be proved by randomizing 12,000 patients.
The authors have given an entertaining account of the most relevant points and differences between the new STEMI guidelines and the prior ones, from 2014. The article features 10 points resembling the ten commandments, which makes it easy to read, compared to the tedious task of reading the complete guidelines.
Neoatherosclerosis was frequently observed in patients who experienced very late stent thrombosis, particularly those with drug-eluting stents. In-stent plaque rupture was the most common cause of thrombosis and it usually occurred in cases in which the original procedure had been carried out while the patient was undergoing an acute myocardial infarction. Macrophage infiltration can be identified in optical coherence tomography (OCT) and it probably is an important indicator of vulnerability for such new plaque.
9- ESC 2018 | ASCEND: Aspirin for Primary Prevention in Diabetic Patients Fails the Cost-Benefit Analysis
The obvious risk of bleeding posed by aspirin was too clear in this work, casting a shadow of doubt over the indication of aspirin for primary prevention in diabetic patients.
The European guidelines on hypertension have been updated and now feature differences compared with American guidelines regarding how to diagnose and treat patients with high blood pressure. The main difference particularly lies in how aggressive physicians should be in lowering blood pressure. These data are available from a preview of the document presented at the Meeting on Hypertension in Barcelona, soon to be formally published. Many of the recommendations do not match those in American guidelines.
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