Multivessel disease is often present in ST elevation acute myocardial infarction (STEMI) patients. The AHA/ACC 2021 revascularization guidelines recommend staged complete revascularization as class I, single-setting complete revascularization as class 2b, and recommend against culprit only revascularization. At present, we have more randomized studies (BIOVASC, FIRE and MULTISTAR) comparing staged vs single-setting complete revascularization, but...
The aim of this study was to assess hard end points such as death or MI in patients with acute coronary syndrome (ACS) presenting hemoglobin levels lower than 10 mg/dl. It was a randomized multicenter double blind trial including 3506 participants. The study looked at different transfusion strategies, comparing restrictive strategy with 7-8 g/dl hemoglobin...
This is a multicenter randomized study including 2,850 patients with acute coronary syndrome. Patients were randomized to: dual antiplatelet therapy (DAPT) with ASA and ticagrelor during one month (1,426 patients), followed by ticagrelor monotherapy for 12 months, while the other group received DAPT with ASA and ticagrelor during 12 months (1,424 patients). This study was...
Dual antiplatelet therapy (DAPT) is the current standard for preventing thrombotic events in high-risk patients with coronary artery disease, as well as in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). However, this approach increases the risk of bleeding. To reduce this risk, there have been studies that discontinued the use of...
Abbreviated dual antiplatelet therapy in patients at high risk for bleeding and acute myocardial infarction. Patients with acute coronary syndrome (ACS) who undergo stent placement (percutaneous coronary intervention, PCI) conventionally require at least 12 months of dual antiplatelet therapy (DAPT) to reduce ischemic events. Patients with ACS who are also at high risk for bleeding...
Acute coronary syndromes (ACS) involve high mortality risk, especially ST elevation ACS. Their treatment is based on reperfusion, dual antiplatelet therapy (DAPT) and anticoagulation, with enoxaparin (1 mg/kg twice a day) as the preferred anticoagulant according to the contemporary guidelines. 2.5 mg or 5 mg doses of rivaroxaban might be valid alternative treatments for this...
Event predictors in patients with plaque erosion and no stenting. A third of all acute coronary syndrome (ACS) cases are caused by plaque erosion. In the initial EROSION study, it was shown that patients with plaque erosion (as evidenced by OCT, with stenosis <70%, TIMI III flow, and asymptomatic) were stabilized without stent implantation (no...
Current guidelines recommend 12-month dual antiplatelet therapy (DAPT) after DES stenting for acute coronary syndrome (ACS) because of elevated MACE risk. The development of more modern stents, with thin and ultrathin struts, compared against prior versions, has resulted in more effective devices in terms of stent thrombosis and restenosis. Prolonged DAPT has been associated with...
The inclusion of fractional flow reserve (FFR) has changed how coronary interventions are treated. Current guidelines endorse its use in intermediate lesions with no evidence of ischemia in non-invasive studies in patients with multivessel disease. The original RIPCORD (Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain) study proposed...
Non-adherence to medication in patients with acute coronary syndrome (ACS) remains to be solved; the use of polypills and a closer follow up have been tried out (follow up calls and motivation groups). Antiaggregation guidelines recommend dual antiplatelet therapy (DAPT) for at least one year after ACS. Adherence to drug treatment is comprised of multiple...