Coronary disease articles

Los 10 mandamientos de las nuevas guías de infarto con ST de la ESC

Mechanisms of Post PCI Persistent Angina

Mechanisms of Post PCI Persistent Angina

Angina persistence or recurrence after PCI can affect between 20 to 40% of patients in the short and mid-term. This might be true despite PCI optimization using FFR, intravascular ultrasound and the latest generation stents. This problem is associated with high healthcare cost, which can double in patients with recurrent or persistent angina compared against

Balancear el riesgo de sangrado vs trombótico para definir el tiempo de doble antiagregación

Can Antiplatelet Therapy Affect the Life of Coronary Grafts?

The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing myocardial revascularization surgery is unclear. What does seem somewhat certain is that some antiplatelet therapy is necessary to prevent early thrombosis, mainly in vein grafts, but (as opposed to what happens with angioplasty) there are other relevant factors such as

FFR para guiar la revascularización en SCA

FFR to Predict CABG Result: All Benefits in a Population Much Too Pure?

Coronary artery bypass graft (CABG) anastomosed to one vessel with normal or nearly normal fractional flow reserve (FFR) have poorer graft patency at one year compared against anastomosed grafts to vessels with functionally significant lesions shown by FFR. However, the recent study FARGO (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization) did not show

La anticoagulación jugando un papel controvertido en el TAVI

PCI and Anticoagulation: What is the best strategy?

Most patients with atrial fibrillation require anticoagulation to reduce the risk of stroke or systemic embolization. Today, this is achieved with the new direct oral anticoagulants, which present lower intracranial bleeding risk compared against the old vitamin K antagonists. On the other hand, approximately between 5% to 10% of patients receiving PCI also present atrial

Por primera vez se publican guías de prevención primaria ¿Serán útiles en todos los pacientes?

Primary Prevention Guidelines Published for the First Time: Are They Useful for All Patients?

The American College of Cardiology/American Heart Association (ACC/AHA) have recently published primary prevention cardiovascular disease guidelines. They were originally considered very useful for general practitioners who had no choice but to review separately expert consensus or clinical practice guidelines for hypertension, cholesterol, diabetes, etc. Now, everything is concentrated in a single reference document. But is

Monto de isquemia basal en pacientes con múltiples vasos y evolución a largo plazo

Amount of Baseline Ischemia in Patients with Multivessel Disease and Long-Term Progress

According to this recent analysis of the MASS II trial, which will soon be published in JAMA, baseline ischemia is not associated with events at 10 years in patients with chronic stable angina. The ischemic burden induced through exercise does not predict events or long-term ventricular function. Such data add some suspense to the results

Estenosis aórtica severa asintomática en añosos: ¿cuándo intervenir?

How to Prevent Pharmacological Overtreating in the Elderly

Cardiovascular risk increases dramatically with over the years, which almost inevitable leads to treating the elderly with statins, based on risk. To prevent over treatment, we need to identify fragile patients (bed-ridden or with dementia), whose condition might make this treatment futile on the one hand, and on the other hand, patients who regardless their

Score de Calcio, “dónde está” parece más importante que “cuánto hay”

Calcium Scoring: “Location” Seems to Be More Important than “Percentage”

The presence of a high percentage of calcium in the left main coronary artery is independently associated with a 20–30% greater risk for cardiovascular and all-cause death in asymptomatic adults. This highlights the fact that calcium location, and not only amount, is important. Calcium scoring reports from computerized tomography (CT) usually inform only that: how

DES con polímero bioabsorbible vs Bare Metal Stents en angioplastia primaria

DES with Bioresorbable Polymer vs. Bare Metal Stents in Primary PCI

Long after myocardial revascularization guidelines had established no medical reason justifies the use of bare metal stents (BMS), along comes this study to refresh the old trials comparing drug eluting vs bare metal stents in the context of primary PCI. The problem for many countries is that primary PCI obviously occurs in the context of

¿Se justifica utilizar filtro de protección distal en los puentes venosos?

After Much Toing and Froing, Gastrointestinal Protection Is Back to the Forefront

Several clinical guidelines differ in their recommendation regarding the prescription of proton pump inhibitors to patients being treated with dual antiplatelet therapy after infarction. In 2015, the European Society of Cardiology (ESC) recommended their use in patients with high bleeding risk; however, in the 2017 update that recommendation became general after the assumption that, for

Momento óptimo para revascularizar un infarto con elevación transitoria del ST

Peri-Procedural Infarction in Angioplasty vs. Surgery in the Left Main Coronary Artery

According to the EXCEL trial, peri-procedural infarction was more common after left main coronary artery surgery compared with angioplasty, and it was strongly associated with increased 3-year mortality after controlling all possible confounding variables. This increased mortality was only present in extensive infarctions with an increase in CK-MB ≥10×. The EXCEL trial seems to want

Top