In the context of an ST-segment elevation myocardial infarction, primary angioplasty to treat the culprit lesion improves the prognosis. The role of angioplasty in unrelated arteries is not well established. Between 2008 and 2013, 465 patients with myocardial infarction underwent primary angioplasty and were randomized to preventive (234 patients) vs non-preventive angioplasty (231 patients). The…
PARIS: Interruption of dual antiplatelet treatment can be safe depending on the clinical context and treatment time
The cessation of dual antiplatelet treatment increased the risk of post coronary intervention adverse events. It is unclear whether the risk varies through time or if it depends on the reason for the interruption or both. The PARIS (patterns of non-adherence to anti-platelet regimens in stented patients) register is a prospective, observational study in patients…
LINC: The LUCAS device failed to demonstrate benefit in cardiac arrest patients.
Each year between 300,000 and 400,000 people suffer an out-of-hospital heart attack in Europe. Only between 5% and 7% of these patients survive and are discharged. Cardiopulmonary resuscitation guidelines recommend manual chest compression with few intervals wherever possible. Manual chest compression only achieves between 20 and 30% of normal blood flow and is difficult to…
PRAGUE 14: Anti-thrombotic therapy before non-cardiac surgery may be associated with a higher incidence of bleeding.
The majority of coronary patients are under anti-thrombotic therapy and its interruption may increase cardiovascular risk, while on the other hand, continuation during a surgical procedure may increase the risk of bleeding. This study, which included 1211 patients who underwent non-cardiac surgery, compared the interruption of anti-thrombotic therapy at least 7 days prior vs continuing…
DECAAF: Pre ablation magnetic resonance in patients with atrial fibrillation is capable of detecting the degree of fibrosis and predicting the success of the procedure.
260 patients with atrial fibrillation were included who underwent nuclear magnetic resonance 30 days before ablation and 90 days following. The patients were classified into four groups according to the degree of fibrosis: stage 1 ( < 10% fibrosis), stage 2 ( > 10% and < 20% fibrosis), stage 3 (> 20% and < 30%…
INTIME: Home monitoring of severe heart failure patients gives promising results.
Rehospitalization or death due to worsening heart failure is often preceded by changes in clinical parameters, weight or arrhythmias. The home monitoring device has the ability to detect these tendencies in time for intervention. 716 patients with heart failure and reduced ejection fraction (<35%) who had implantable cardioverter defibrillator and/or resynchronization therapy were randomized to…
ACCOAST: Pretreatment with prasugrel showed no benefits and increased bleeding in patients with non-ST segment myocardial infarction.
This study evaluated the administration of prasugrel at the time of diagnosis of non-ST segment acute coronary syndrome vs administration at the time of the coronary angiography without indication of angioplasty. 4033 enrolled patients with non-ST segment acute coronary syndrome and positive troponin levels were randomized and who would undergo the angiography between 2 and…
Hokusai-VTE: Endoxaban shows solid results versus warfarin in venous thromboembolism .
The venous thromboembolism is the third most common cardiovascular disease after acute myocardial infarction and stroke . Usual treatment is to use low molecular weight heparin followed by vitamin K antagonists Other studies have shown that the new oral anticoagulants with or without initial heparin are effective alternatives. The endoxaban is a direct Factor Xa…
RE-ALIGN: Dabigatran in mechanical valves. Suspended early due to more bleeding and thrombotic events.
The use of vitamin K antagonists provides excellent protection against thromboembolic complications in patients with mechanical valves, however long-term INR monitoring is needed. Dabigatran is an oral direct thrombin inhibitor which was shown to be effective in patients with atrial fibrillation. Based on these promising results this study was designed to evaluate its use in…
TASTE: Thrombus aspiration in primary angioplasty failed to show benefits at 30 days
The clinical benefit of thrombus aspiration during angioplasty in patients with ST-segment elevation myocardial infarction is uncertain. The purpose of this work was to test if thrombus aspiration reduces mortality. This was a multicenter, prospective, randomized and controlled study that included patients with ST-segment elevation myocardial infarction within 24 hours of evolution. The catheters used…
TAO trial: Otamixaban without advantages as the only anticoagulant in acute coronary syndromes
Despite progress in antiplatelet, anticoagulant therapy and invasive strategy, patients with non-ST-segment elevation acute coronary syndrome present an elevated risk of events. There is no consensus on the use of a single anticoagulant which can be administered in the Coronary Unit and also at the time of coronary intervention. The anticoagulant direct factor Xa inhibitor,…