Transcatheter aortic valve replacement (TAVI) with the new generation balloon expandable valve is at least as good as surgery in intermediate risk patients with severe symptomatic aortic stenosis. For those that can be accessedfemorally, TAVI seems even better than surgery. In all, 2032 intermediate risk patients were randomized in 57 centers to TAVI with Sapien…
The SAPIEN 3 Valve Resulted Superior to Surgery in an Observational Study
The last generation of the balloon expandable valve resulted superior to surgery in intermediate riskpatients, in a registry analyzis. Patients treated with the SAPIEN 3 valve showed lower rates of death, stroke and paravalvular leak at one year than patients undergoing surgery. This third generation improves the SAPIEN XT with a skirt designed to prevent…
CoreValve US Pivotal: at 3 Years, the Self-Expanding Valve Maintains Its Advantage vs. Surgery
At 3 year follow up, the CoreValve US Pivotal study on high risk elderly patients, the self-expanding valve showed a lasting benefit vs. surgery. These findings could suggest that the self-expanding valve should be considered the preferred treatment in patients with symptomatic severe aortic stenosis at increased risk for surgery. The study included 797 patients…
PARTNER 1 in +90 Year Old Patients: TAVI and the Age Paradox
A new analyzis of the PARTNER 1 trial showed that patients over 90 undergoing transcatheter aortic valve replacement (TAVI) show no increase in mortality or major cardiovascular events rates, compared to younger patients. In fact, patients over 90 undergoing TAVI have the same life expectation of someone the same age with no aortic stenosis. In-hospital…
DANAMI 3: Deferred Stenting and Ischemic Postconditioning Have No Benefit in Primary PCI
Both ischemic postconditioning and deferred stenting showed no benefit in randomized studies conducted as part of the DANAMI 3 program. Both the DANAMI 3-DEFER and the DANAMI 3-iPOSTshowed slight improvements in ventricular function after intervention, but clinical end points saw no change. This does not mean that outcomes should be considered negative, only that the…
Morphine Increases Platelet Reactivity in Infarctions
The use of morphine in patients undergoing ST elevation acute coronary syndromes is associated to higher platelet reactivity and lower thrombolysiscapacity, according to this small study. The negative effects seem to resolve 2 days after administration. This transient effect is believed to be the result of the inhibition of the normal muscular activity of the…
EARLY-BAMI: Metropol Showed No Reduction in Infarct Size.
EARLY-BAMI outcomes show the endovenous administration of metropol before primary PCI does not reduce infarct size. This double blind study randomized 683 STEMI patients within 12 hours of symptom onset to endovenous metropol (two 5 mg bolus, the first in the ambulance and the second before PCI) vs. placebo. Primary end point was infarct size…
New Meta-Analysis Shows Similar Mortality between Bivalirudin and Heparin
This meta-analyzis of contemporary studies comparing the safety and efficacy of bivalirudin vs. heparin showed no differences in mortality between the two drugs and, consistently with other studies, bivalirudin was associated with an increased risk of acute stent thrombosis. During ACC 2015, the MATRIX study did succeed in showing global differences between the two drugs…
HOPE 3: Reducing LDL Improves Prognosis in Intermediate Risk Patients
In a large cohort of intermediate risk patients with no known CAD, treatment with low doses of statins in addition to an angiotensin receptor blocker and a diuretic, reduce the risk of cardiovascular events, compared to placebo. These are the main findings of the HOPE 3 trial (Heart Outcomes Prevention Evaluation) that randomized 12705 patients,…
ixCELL-DCM: Stem Cell Therapy Improves Outcomes in Patients with Heart Failure
Enhanced autologous bone marrow stem cell therapy improves clinical cardiac events in patients with heart failure and reduced ejection fraction resulting from ischemic heart disease and dilated cardiomyopathy. Globally, percutaneous intra-myocardial delivery of stem cells resulted in a significant 37% reduction in all-cause death, rehospitalization and sudden worsening for heart failure. This study randomized patients…