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.
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.
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.
4- 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.
Certain coronary lesions have been historically discouraged for endovascular treatment. Among these can be found left main coronary artery lesions, multivessel disease, and proximal anterior descending artery lesions. As a matter of fact, the latter is actually considered separately as a criterion for choosing the revascularization method.
During SOLACI’s coverage of the TCT 2017 Congress in Denver, Colorado, we already mentioned some of the outcomes of this study that has arrived to revolutionize clinical practice, given the differences between its results and those of the classic SHOCK trial, which has marked for almost 20 years the treatment strategy for patients with infarction complicated by cardiogenic shock.
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 ARRIVE trial, presented at the European Society of Cardiology (ESC) Congress 2018 and simultaneously published in The Lancet, joins the ASCEND trial and together force aspirin against the ropes as regards the primary prevention setting.
In patients with presumed paradoxical embolism through a patent foramen ovale (PFO) who are at high risk of recurrent thromboembolic events, percutaneous PFO closure is an alternative to pharmacological treatment. This closure has been shown to be safe and feasible with different devices including various technologies based on an umbrella, a disc or a bioresorbable design. Whether these differences (even the slightest) in structure, design, and composition have an impact on clinical outcomes is still unknown.
10- 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. According to the ASCEND trial, presented at the European Society of Cardiology (ESC) 2018 Congress and simultaneously published in NEJM, aspirin reduces cardiovascular events as primary prevention, but the cost in terms of major bleeding is too high to support its use in this setting.
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