Read the best articles on coronary heart disease from 2018 at solaci website.
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.
3- “Troponinitis” or “Troponinemia”: Terms that Trivialize Troponin Elevation Without a Specified Diagnosis
Troponin elevation is a common finding in acute patients admitted by an emergency service, even in the absence of an acute coronary event. There are patients in whom we simply cannot identify the origin of such troponin elevation. Initially, we relied on this marker as an exclusive marker of acute coronary syndrome. In consequence, many patients with troponin elevation sooner or later ended up in the cath lab, despite their inconclusive electrocardiograms and signs and symptoms of other diseases.
The new European guidelines on myocardial revascularization were developed by a joint effort of the European Society of Cardiology (ESC) and the European Association of Cardiovascular Surgery (EACTS). These guidelines are intended to support clinical practice with pragmatic recommendations based on currently available evidence and on personal experience, whenever evidence is missing.
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 Fourth Universal Definition of Myocardial Infarction is a document developed jointly by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF).
In this large randomized trial, there were significant differences as regards both target-lesion failure and target-vessel-related infarction, which persisted through a 2-year follow-up and favored treatment with an ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (Orsiro) compared with the gold standard, a durable-polymer everolimus-eluting stent (Xience).
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.
Up to 20% of patients undergoing left main PCI require a 2-stent technique, and this number should most likely grow after the DKCRUSH-V outcomes. However, this study contradicts the DKCRUSH-V and brings us back to “the simpler the better”, since patients undergoing 1 stent left main PCI presented less revascularization and less target vessel failure than patients undergoing 2 stent PCI. Even more, it suggests extending DAPT when using a 2-stent technique.
The decision to be made with a treatment-free patient with systolic blood pressure over 160 mmHg or diastolic blood pressure over 100 mmHg is an easy one. All guidelines agree: treatment should be started immediately alongside lifestyle changes.
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