Highlights ESC 2016 articles

Andexanet Alfa: a Good Antidote against Anti Xa Agents

Andexanet Alfa: a Good Antidote against Anti Xa Agents

Andexanet alfa induces rapid reversion of Xa inhibitor effect in patients with active major bleeding, according to preliminary observations of the ongoing study ANNEXA-4, currently randomizing patients.   This work was presented in Rome in the context of the European Society of Cardiology annual meeting, and simultaneously published in the New England Journal of Medicine.

DES: Best Option in Saphenous Vein Grafts

These results confirm that, despite being used less and less worldwide, DES (drug eluting stents) are the best option in saphenous vein grafts.   Saphenous vein graft atherosclerosis has a different pathophysiology to that of native arteries, and PCI in this context is less effective because of high risk of friable thromboembolic material, faster plaque

OCT Improves Outcomes in Non ST Elevation ACS

This study presented at the ESC and simultaneously published in Circulation, is the first randomized controlled study to support the use of optical coherence tomography (OCT) in the context of ACS patients.   The study randomized 240 patients undergoing non ST elevation acute coronary syndrome to OCT guided PCI (before and after PCI) vs. conventional

Patients with Plaque Erosion: Management without Stenting

This small study presented at ESC and simultaneously published in the European Heart Journal evaluated patients undergoing acute coronary syndrome caused by plaque erosion identified by optical computed tomography (OCT). The study showed it can be managed with conservative antithrombotic therapy and without stenting.   Patients with plaque erosion can receive dual antiplatelet therapy, ticagrelor and aspirin

Six Month DAPT Enough for Nobori BES

Patients treated with A9 biolimus eluting stent with biodegradable polymer (Nobori, Terumo) can receive only six months of dual antiplatelet therapy (DAPT) with no increase in adverse events, compared against more prolonged treatments.   The net adverse clinical and cerebrovascular events that included all cause death, MI, cerebrovascular events and major bleeding was: 1.92% for

Current Bare-Metal Stents: Similar to DES in the Very Long-Term

The largest randomized trial in history found no difference in the primary endpoint of death and nonfatal infarction between current conventional stents and drug-eluting stents at over 5 years in patients with stable or unstable coronary disease. As expected, NORSTENT did find a difference in revascularization rates between both groups.   This study presented at the

Primary PCI: Similar Results During Day and Night

Patients with ST-segment elevation myocardial infarction included in the CHAMPION PHOENIX trial admitted during nights, weekends, and holidays presented the same prognosis and good clinical outcomes as those who were admitted during regular daytime hours.   Prior studies had indicated that off-hours admission was associated with worse outcomes; however, this particular analysis contradicts such a

Prasugrel vs. Ticagrelor in Primary Angioplasty

The choice of prasugrel or ticagrelor for patients with acute myocardial infarction undergoing primary angioplasty makes no difference, at least in the short term.   This study was terminated prematurely and thus lost statistical power, which means that any interpretation of the lack of difference between the two antiplatelet drugs must take into account such

A Study on Valve Thrombosis After TAVI

This study, presented in Rome at the European Society of Cardiology Congress 2016 and published simultaneously online in the Journal of the American College of Cardiology (JACC), has identified a post-TAVI valve thrombosis rate of 7% using multidetector computerized tomography (CT). However, the vast majority of cases were completely asymptomatic.   Previous studies had shown