In patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (primary PCI), multivessel disease is observed in up to 40% of cases. The optimal timing for revascularizing non-culprit lesions in these patients without cardiogenic shock remains a controversial issue. European guidelines recommend completing revascularization during the initial procedure or within 45 days…
Revascularization Timing in Acute Coronary Syndrome
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…
ULTIMATE III: Use of IVUS for Coronary De Novo Lesion Drug Coated Balloon Angioplasty
Percutaneous coronary intervention (PCI) with drug eluting stents (DES) can present limitations, especially in the form of stent thrombosis or instent restenosis (ISR). These findings have furthered the development of drub coated balloons (DCB). The safety and efficacy of DCB have already been shown in the context of ISR and de novo small vessel coronary…
Intravascular Lithotripsy: Outcomes and Trends in the Treatment of Calcified Coronary Lesions
Lately, the complexity of percutaneous coronary artery interventions (PCI) has seen an increase, mainly driven by the increasing prevalence of coronary lesion calcification, which represents a significant challenge for interventionists. Untreated calcification might result in insufficient stent expansion, a high risk factor of thrombosis and instent restenosis. Historically, several devices have been used to treat…
Predictors of DCB Failure in De Novo Lesions
Percutaneous coronary intervention (PCI) with drug coated balloons (DCB) is a viable alternative, especially in patients at high risk of bleeding, side-branch lesions in coronary bifurcation, or in small coronary segments. De novo heart disease treated with DCB has been shown non-inferior to conventional DES stenting, according to the PICCOLETO-II trial. However, these interventions are…
Prehospital Crushed vs. Integral Prasugrel in STEMI Patients with Large Myocardial Area at Risk
Timely percutaneous intervention of STEMI patients effectively reduces MI size and mortality, which currently makes it the first line of treatment. A fundamental aspect is activation and platelet aggregation, which is why, in addition to creating networks to optimize STEMI treatment, prehospital drug treatments have been implemented. The COMPARECrush looked at whether early and powerful…
Biolimus vs Paclitaxel Coated Balloons for the Treatment of In-Stent Restenosis
Drug eluting stent (DES) in-stent restenosis (ISR) is currently a challenging, seeing as it often requires repeat revascularization. The use of drug coated balloons (DCB) offers the advantage of delivering the drug without the need for re-stenting. This highlights the importance of the technological development of DCB, with diverse drug formulations and coating technologies. As…
Non-ST-Segment Elevation Myocardial Infarction in Elderly Patients
The world population is aging, and cardiovascular diseases are the leading cause of death in Western countries. It is increasingly common to find patients aged 70 or older with non-ST-segment elevation acute myocardial infarction (NSTEMI). However, this group has been excluded from most studies, and there is not enough information to determine whether a conservative…
QFR Analysis of Coronary Lesions with TAVR
While transcatheter aortic valve replacement (TAVR) has shown benefits, significant coronary artery disease affects 50% or more of patients who undergo such procedure. However, it is still unclear which is the best treatment strategy or how to handle this condition. Quantitative flow ratio (QFR) could be a non-invasive option to assess the severity of coronary…
Age and Microvascular Function in Patients without Obstructive Coronary Artery Disease
At present, there is increasing interest in the microvascular function of patients with and without obstructive coronary artery disease of different ages. However, these “physiological” effects of age on microvascular function have never been directly quantified on patients without obstructive CAD. Prior studies have focused on patients with angina and obstructive CAD, and the effects…
Invasive Correlation (CFR – IMR) with Coronary Slow Flow
Prior registries have shown that 65% of patients with chronic coronary syndrome (CSS) and angina do not present obstructive atherosclerosis. This phenomenon, called myocardial ischemia with no obstructive coronary arteries (INOCA) is more common in women and has been associated with high hospitalization costs and diminished quality of life. INOCA patients can present microvascular dysfunction…