Atrial fibrillation is the most common arrhythmia and its combination with a history of acute myocardial infarction or coronary angioplasty is quite frequent. According to this study (recently published in JACC), in a real-world population, the combination of direct anticoagulant agents and dual antiplatelet therapy reduces significantly the risk of bleeding and provides similar thromboembolic…
Myocardial Revascularization Surgery Hits a Plateau
Hopes were raised high by the ARTS study, when set to show the benefit of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery compared over the use of a single internal mammary artery (SIMA) at 10 year follow up, but only one sub-study was able to show an advantage over radial grafts.…
Practical Management of Coronary Perforations
Coronary perforation has an incidence of 0.5% and it is associated with a 13-fold increase in in-hospital events and a 5-fold increase in 30-day mortality. This event is so catastrophic that its management has become indispensable knowledge to all interventional cardiologists. This accident is most frequently provoked by artery over-dilation caused by a balloon or…
Complete Revascularization Improves Long-Term Prognosis in Acute Coronary Syndromes
Going beyond the culprit artery during angioplasty was associated with lower mortality, although this was a cohort study that should be confirmed through randomized trials. According to this new observational study, patients experiencing non-ST-segment elevation myocardial infarction with multivessel disease seem to benefit from complete revascularization during initial angioplasty. This study, published online before…
iFR Assessment of Intermediate Aortic Stenosis Lesions Consolidates
Once a big void that prevented us from effectively assessing functional compromise, intermediate aortic stenosis has made us treat many lesions “just in case”, to save us what would be a complicated procedure, had a valve been placed. Auspiciously, some light has been shed by several, most welcome, studies simultaneously published in J Am Coll…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
ICELAND MI: Unrecognized MI Have Similar Prognosis to Recognized MI
At 10-year follow-up, unrecognized or silent MIs have similar mortality to clinically recognized MI and, even though this does not justify routine screening, these findings call for more aggressive prevention. Unrecognized MI, detected by MRI, is associated to long term mortality risk similar to that of recognized MI; therefore, these patients have higher risk…
Discharge During the Weekend After Cardiac Surgery Is Not Associated with Readmissions
According to this new work (soon to be published in Ann Thorac Surg), discharging a patient during the weekend or a holiday after cardiac surgery is not associated with higher rates of readmission compared with patients discharged during weekdays. A total of 4877 patients were discharged after cardiac surgery in high-volume sites in the United States. Among them,…
Safety of Lesion Deferral with iFR or FFR in Both Stable and Acute Patients
Overall, deferral of lesion revascularization is equally safe with both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), with a low rate of events of about 4%. Lesions were more frequently deferred when iFR (as opposed to FFR) was used for functional assessment. Among patients with deferred lesions, acute patients experienced significantly more events…
EXCEL Sub-Analysis: Angioplasty vs. Surgery in Chronic Renal Insufficiency
EXCEL patients with chronic kidney disease and left main coronary artery disease have higher rates of acute renal failure and other events compared with the general population. However, acute renal failure was less frequent with angioplasty than with surgery, while other events such as death, stroke, or infarction at 3 years were similar for both revascularization…
The 10 most read articles of September
1- High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. Read more 2- A Simple…
