The vulnerable features of plaque are independently associated to functional measurements done under hyperemia far better than baseline measurements such as iFR. These findings suggest that not only stenosis severity but also plaque features contribute to functional measurements. This is a sub-study of the PACIFIC (Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT…
Virtual ACC 2020 | TICO: Ticagrelor Monotherapy in Acute Coronary Syndromes
Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces…
Virtual ACC 2020 | ISCHEMIA-CKD: Invasive Strategy vs. Medical Treatment in Higher Risk Patients
This pre-specified protocol originally included 777 patients with chronic kidney failure. These patients are a special population of higher risk where we might be able to see the advantage of a more aggressive initial strategy. Death or MI rate (combined primary end point) resulted 36.4% for the invasive strategy vs. 36.7% for the initially conservative…
Virtual ACC 2020 | PRECOMBAT: 10 Years for Surgery vs. Angioplasty in Left Main Coronary Artery Disease
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few…
Virtual ACC 2020 | ISCHEMIA: Quality of Life, Not a Soft Endpoint
In the general study, an invasive strategy followed by revascularization (when necessary) vs. an initially conservative strategy with OMT resulted similar in patients with stable CAD with moderate to severe ischemia. A secondary end point of this analysis were angina symptoms and quality of life. Angina symptoms, functional activity and quality of life were assessed…
Virtual ACC 2020 | Relationship between Ischemia Severity and CAD
The ISCHEMIA trial enables countless sub-studies. Many of them have made part of the virtual ACC 2020, and among them you will find the present study. This analysis finds it is the anatomy — rather than ischemia — which predicts events. And even more interesting is the fact that revascularizing this particular anatomy will not…
Virtual ACC 2020 | Controversial Trial ISCHEMIA Finally in NEJM
In November 2019, during the American Heart Association (AHA) 2019 Scientific Sessions, researchers presented this revolutionary trial that called the attention of all cardiologists. We had to wait until March to read the fine print; back then, a global pandemic such as the current one seemed out of a science-fiction tale. The world has changed…
Virtual ACC 2020 | Colchicine After Infarction: Good Results and Cost-Effectiveness
Low doses of colchicine reduce the risk of ischemic events after an acute myocardial infarction, according to the COLCOT trial, originally presented at the American Heart Association (AHA) 2019 Scientific Session and simultaneously published in the New England Journal of Medicine (NEJM). The new information featured at the virtual ACC 2020 refers to its cost-effectiveness. Colchicine…
Virtual ACC 2020 | More data from ISCHEMIA: Women with More Symptoms but Less Ischemia
The ISCHEMIA trial will keep shedding light. The latest data show important differences between men and women as regards disease severity and its correlation with symptoms. Women have more angina than men but have less extensive ischemia. These findings were presented virtually at the ACC 2020, cancelled by COVID19, and suggest that, in addition to…
Virtual ACC 2020 | COMPASS Sub-Analysis: Diabetes Increases the Benefit of Rivaroxaban Combined with AAS
In patients with stable coronary or peripheral artery disease, diabetes increases the benefit of combining low doses of rivaroxaban and aspirin vs. aspirin alone. This analysis was pre-specified in the COMPASS protocol and was presented virtually for the ACC 2020 and simultaneously published in Circulation. Patients with diabetes, showed numerically greater reduction in terms of…
16 Years of Superiority of Primary Angioplasty
The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial showed the 30-day superiority of patient transport to a primary angioplasty site vs. fibrinolysis at the hospital where the patient had been originally admitted. Those 30-day results became a landmark in the history of interventional cardiology. However, some suspected that such initial benefit could fade away over…