Coronary disease articles

Impella

Impella: A Revolutionary Device Being Questioned

Impella: A Revolutionary Device Being Questioned

Observational studies (with their subsequent limitations) show a possible increase in adverse events and costs with the use of the Impella device. Two large observational studies stirred doubts regarding the good performance of new circulatory support devices in real-world daily clinical practice. There were more adverse events, including in-hospital death and major bleeding, and more

Soon after the EXCEL “Scandal” the NOBLE 5-year Outcomes Come Out: Mere Coincidence?

There is no such thing as coincidence, at least not for the evidence-based medical science. This is what the NOBLE 5-year outcomes, soon to be published in the Lancet, seem to say, in line with the BBC exposé of the EXCEL study. The NOBLE study randomized patients with left main disease to compare PCI vs

Escándalo con los resultados del EXCEL que hicieron “caer” las últimas guías

Latest Guidelines “Dropped” After Scandal Over EXCEL Results

The European Association for Cardio-Thoracic Surgery (EACTS) formally withdrew its support for the latest coronary revascularization guidelines following a BBC investigation suggesting that data from the EXCEL trial might have been manipulated. The recommendations for left main coronary artery revascularization featured in the 2018 guidelines, which were written jointly with the European Society of Cardiology

Escándalo con los resultados del EXCEL que hicieron “caer” las últimas guías

The EXCEL Authors’ Answer to the BBC Investigation

Do to an investigation carried out by the BBC that led to the withdrawal of EACTS support from the latest coronary revascularization guidelines, the authors of the EXCEL study (indicated by this research) provided the following answers. -Defining Peri-Procedural Infarction: All researchers involved (including surgeons) agreed that the universal definition of infarction was not right

Mechanisms of Infarction in Coronary Arteries with Non-Significant Lesions

Infarctions with non-obstructive coronary artery disease, also known as MINOCA (myocardial infarction with nonobstructive coronary arteries), often present plaque rupture and thrombi associated with the affected myocardial territory. In these patients, optical coherence tomography (OCT) is of great value to identify the “culprit”. Even though atherosclerosis has been identified as a potential MINOCA mechanism, the

Pretratamiento con estatinas para prevenir eventos peri angioplastia carotidea

Secondary Prevention: A Responsibility We Should Not Delegate

After coronary angioplasty, the use of drugs whose efficacy for the reduction of major events has been proven declines over time, which is associated with worse patient prognosis. Sometimes, without meaning to, we convey to patients the idea that, once the stent has been implanted, the artery is “cured” or that the only potential future

¿Las angioplastias primarias a la madrugada siguen teniendo mayor mortalidad?

Off-hours Primary PCI Still Have the Highest Mortality Rate?

According to this contemporary study, in the current organized STEMI network, patients admitted to a tertiary high-volume center for primary PCI are managed similarly and have similar prognosis regardless admission time.  Several prior studies have shown primary PCI during off-hours (6 pm to 8 am) had worse outcomes vs. on-hour interventions (8 am to 6

Consenso internacional para prevenir la oclusión radial luego de las intervenciones

International Consensus to Prevent Radial Artery Occlusion After Interventions

This study provides the steps to follow in order to prevent or at least reduce radial artery occlusion after using it as an access for a diagnosis or treatment study. The use of transradial access is exponentially increasing worldwide due to its lower chance of bleeding events and vascular complications than transfemoral access. Radial artery

AHA 2019 | COMPLETE: la revascularización completa es superior por tratar otras placas vulnerables

AHA 2019 | COMPLETE: Complete Revascularization Is Superior since It Treats Other Vulnerable Plaque

This COMPLETE sub-study using optical coherence tomography (OCT) showed the prevalence of vulnerable lesions other than the culprit which should provide a physiopathological explanation of the benefit of complete revascularization observed in the original study.  STEMI patients with multivessel disease will benefit from complete revascularization in terms of reduced cardiovascular death and repeat MI according

AHA 2019 | ISCHEMIA-CKD: insuficiencia renal crónica y enfermedad coronaria estable

AHA 2019 | ISCHEMIA-CKD: Chronic Kidney Disease and Stable Coronary Disease

Among patients in the main ISCHEMIA trial, those with chronic kidney disease are a particularly high-risk subgroup. However, an invasive strategy with coronary angiography and revascularization did not improve the rate of events, similarly to what happened in the general population for the aforementioned trial. The rate of death or acute myocardial infarction was 36.4%

La angina microvascular podría tener gradientes de riesgo

Microvascular Angina Could Have Risk Gradients

This study recently published in JACC paves the way to identifying higher risk patients among those with no epicardial coronary artery disease (CAD) that present angina symptoms.  Evidence of coronary spasm and increased microcirculation resistance in patients with angina (but with no epicardial obstructive CAD) is associated with increased risk of adverse cardiac events.  AT

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