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…
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: 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: 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%…
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…
AHA 2019 | TWILIGHT: Discontinue Aspirin after Acute Coronary Syndrome
This study findings confirm less bleeding at no extra cost of thrombotic events when aspirin is discontinued after an acute coronary syndrome (ACS). In the same line as the original TWILIGHT, this study focused on ACS patients alone (excluding STEMI) and confirmed that aspirin discontinuation after 3-month DAPT to continue with ticagrelor alone, reduced the…
AHA 2019 | ISCHEMIA: The Invasive Approach (PCI or Surgery) Results Similar to Optimal Medical Treatment
After a several year follow up, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) has shown that an invasive approach in addition to optimal medical treatment (OMT) does not offer benefits when it comes to preventing major cardiovascular events compared against optimal medical treatment alone in stable patients with moderate…
Current Mechanical Complications of Infarction
Contemporary data of a recently published large registry show that mechanical complications after infarction are not frequent but maintain a very high mortality rate that does not seem to improve over time. Our information on mechanical complications was outdated and we did not have current data on their incidence and prognosis. Such is precisely the…
The Road Towards a “More Perfect” Angioplasty Is Already Being Traveled
The aim of revascularization, whether through angioplasty or surgery, is to restore adequate flow to the myocardium; that much is obvious. However, after millions of “successful” procedures with the best technology applied to drug-eluting stents and optimal medical treatment, we still have a high ratio of patients who experience new events. Could an optimal angiographical…
Should Post-PCI Biomarkers Elevation Be of Concern?
Elevated markers after PCI in stable patients treated with the latest generation stents continues to happen. However, only the association between biomarker elevation with creatine kinase-myocardial band (CK-MB) should be of concern, sin it was associated with mortality at one year. Post procedural cardiac troponin (cTn) elevation was not associated to future events, according to…
Hours of Sleep and Myocardial Infarction Risk
This is one of the first studies to prospectively assess this association, and its outcomes support the idea that poor sleep is a potential MI risk factor. Even though we need further data to be able to modify the current sleep duration standards as part of life-style change recommendations, it seems reasonable to start bearing…