These Were the Most Relevant Article of 2018 in the Field of Coronary Diseases

1- The CULPRIT-SHOCK Study Is Finally Published in NEJM and It Is Bound to Change Guidelines

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.

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2- ESC 2018 | CULPRIT-SHOCK: 1-Year Results Continue to Support Treatment of the Culprit Artery Only

Increases in the rates of revascularization and heart failure do not justify the early mortality advantage shown by treatment of the culprit artery only in patients with acute myocardial infarction and cardiogenic shock.

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3- EuroPCR 2018 | ORBITA: The Link Between Ischemia and Symptoms Is Still Not Entirely Understood

Invasive physiology tests used in the ORBITA trial could not predict which patients would benefit from angioplasty more than placebo (sham procedure) in terms of the trial’s primary endpoint, improvement in exercise time. These data were presented at EuroPCR 2018 and published simultaneously in Circulation.

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4- Angina Is as Subjective as Any Other Pain

Almost 80% of all patients randomized in this study reported Canadian Cardiovascular Society class II or III angina, and almost all of them (97%) had more than 1 positive non-invasive ischemia test that matched the area of their single diseased coronary vessel. Beyond fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), the study randomized patients to undergo angioplasty or a sham procedure (placebo group). We might have expected angioplasty patients to resolve their symptoms and placebo patients to continue with the same angina functional class. It should be noted that all patients were symptomatic and they all had single-vessel disease, with ischemia shown in more than one functional study.

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5- AHA 2018 | Use of Balloon Counterpulsation According to IABP-SHOCK II Trial

Following up on the 30 day and one year effect, the IABP-SHOCK II trial long term outcomes showed there is not benefit to the use of intraaortic balloon counterpulsation in cardiogenic shock patients undergoing acute myocardial infarction.

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6- On Radiation Protection: Editorial comment by Dr. Ariel Durán

I am pleased to witness the increased amount of scientific papers in high impact journals addressing topics related to radiation protection or the harmful effects of radiation on our patients and primary or secondary operators. Similarly, it is my pleasure to see that SOLACI has acknowledged this growing concern by selecting 5 articles for comment on its website in this occasion.

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7- The Use of Intravascular Imaging to Guide PCI Reduces Cardiovascular Death Risk, Compared to Angiography

Intravascular imaging, which includes ultrasound intravascular (IVUS) and optical coherence tomography (OCT), shows live details that better characterize post stenting plaque, anatomy and outcomes. The already familiar limitations of the angiography has lead us to think that IVUS and OCT could improve clinical outcomes; however, we should still find the evidence to support this claim.

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8- The 10 Commandments of ESC’s New STEMI Guidelines

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.

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9- ACC 2018 | DEFINE-FLAIR Sub-Analysis: iFR More Comfortable, Faster, and Much Cheaper

Using instantaneous wave-free ratio (iFR) to guide decisions on revascularization of intermediate lesions is cheaper than using fractional flow reserve (FFR). Based on costs from the DEFINE-FLAIR trial, researchers estimate the difference to be almost USD 1000.

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10- EuroPCR 2018 | Compare-Acute: FFR or Primary Angioplasty at a 2-Year Follow-Up After Complete Revascularization

Recent studies in patients undergoing acute myocardial infarction showed that a complete revascularization strategy in an acute or subacute setting, whether it be guided through angiography (PRAMI, CvLPRIT) or fractional flow reserve (FFR) (PRIMULTI, COMPARE-ACUTE), improves the combined endpoint of major adverse cardiac events (MACE) when compared with treatment of the culprit artery only. Based on these results, the European Society of Cardiology (ESC) modified the recommendations included in its guidelines on ST-segment elevation myocardial infarction.

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11- EuroPCR 2018 | SYNTAX II: Results at 2 Years for Best Angioplasty vs. Surgery in Multivessel Disease

Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty:

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12- EXCEL Sub-Study: The Site of the Left Main Coronary Artery Lesion Does Not Alter History

The EXCEL study, originally presented at TCT 2016 and published simultaneously in the New England Journal of Medicine (NEJM), showed that angioplasty and surgery in patients with left main coronary artery disease have similar rates of mortality, infarction, and stroke at 3 years.

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13- ESC 2018 | ART: Disappointment with Bilateral Internal-Thoracic Artery Grafts After a 10-Year Follow-Up

Published 5-year results had been neutral for bilateral vs. single internal-thoracic artery grafts, but, at the time, surgeons argued that the time period analyzed was not enough and that a difference would be observed after 10 years of follow-up, once the trial finished. Such follow-up was presented at the European Society of Cardiology (ESC) Congress 2018 and the disappointment was big: bilateral internal-thoracic artery grafts offer no advantage.

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14- AHA 2018 | Freedom Long-Term Follow-up: Still in Favor of CABG

Nearly 8 years later, CABG maintains its benefit over PCI-DES in terms of mortality in diabetic patients with multivessel disease, according to the Freedom trial, presented by Dr. Fuster at AHA and simultaneously published in JACC.

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