After a several year follow up, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) has shown that an invasive approach in addition to optimal medical treatment (OMT) does not offer benefits when it comes to preventing major cardiovascular events compared against optimal medical treatment alone in stable patients with moderate to severe coronary artery disease (CAD).
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2- The Road Towards a “More Perfect” Angioplasty Is Already Being Traveled
The aim of revascularization, whether through angioplasty or surgery, is to restore adequate flow to the myocardium; that much is obvious. However, after millions of “successful” procedures with the best technology applied to drug-eluting stents and optimal medical treatment, we still have a high ratio of patients who experience new events.
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3- Temporal Trends and Outcomes of TAVR in Bicuspids: Are We Any Better?
This large registry has shown bicuspid aortic stenosis (AS) patients have similar mortality with transcatheter aortic valve replacement (TAVR) compared against surgical valve replacement (SAVR). TAVR outcomes in this population are not only similar to SAVR outcomes, but also to TAVR outcomes in patients with conventional aortic valve anatomy. Despite the good news, these outcomes are very short term, and we still ignore how these patients will evolve in the long run.
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4- Current Mechanical Complications of Infarction
Contemporary data of a recently published large registry show that mechanical complications after infarction are not frequent but maintain a very high mortality rate that does not seem to improve over time.
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5- Lower Mismatch Rate with the New Self-Expandable Valves
Prosthesis mismatch (PPM) was introduced by Rahimtoola in 1978 and happens when the effective orifice area of a heart valve prosthesis is too small in relation to patient body size. Surgical valves have been well documented, but there is little information on percutaneous valves.
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The balloon-expandable valve has been granted approval in Europe for treatment of the complete risk spectrum of symptomatic severe aortic stenosis.
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7- Negative Impact of Pulmonary Hypertension in TAVR
The presence of pulmonary hypertension (PH) is frequent in severe aortic stenosis. This can be classified in: isolated pre-capillary PH, isolated post-capillary PH, and combined post-capillary and pre-capillary PH.
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8- Should Post-PCI Biomarkers Elevation Be of Concern?
Elevated markers after PCI in stable patients treated with the latest generation stents continues to happen. However, only the association between biomarker elevation with creatine kinase-myocardial band (CK-MB) should be of concern, sin it was associated with mortality at one year. Post procedural cardiac troponin (cTn) elevation was not associated to future events, according to this study recently published in J Am Coll Cardiol Intv.
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9- AHA 2019 | ISCHEMIA-CKD: Chronic Kidney Disease and Stable Coronary Disease
Among patients in the main ISCHEMIA trial, those with chronic kidney disease are a particularly high-risk subgroup. However, an invasive strategy with coronary angiography and revascularization did not improve the rate of events, similarly to what happened in the general population for the aforementioned trial.
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10- Hours of Sleep and Myocardial Infarction Risk
This is one of the first studies to prospectively assess this association, and its outcomes support the idea that poor sleep is a potential MI risk factor.
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