The world population is aging, and cardiovascular diseases are the leading cause of death in Western countries. It is increasingly common to find patients aged 70 or older with non-ST-segment elevation acute myocardial infarction (NSTEMI). However, this group has been excluded from most studies, and there is not enough information to determine whether a conservative…
Patients with CABG History and new N-ST ACS: Routine Invasive Strategy?
Multiple studies support the use of an early invasive approach in high risk patients with non-ST elevation acute coronary syndrome (NST ACS). This benefit of an invasive strategy over the expected management has been shown in randomized studies and meta-analysis. Patients with a history of cardiac artery bypass graft (CABG) represent approximately 10% of ACS…
Microvascular Resistant Reserve: Impact on STEMI Patients
Coronary Microvascular Dysfunction (CMD) is being increasingly considered a common consequence of STEMI. Its presence partly explains the persistence of angina symptoms in over 50% of patients after PCI, despite successful epicardial artery reperfusion. Also, CMD has been independently associated with worse left ventricular ejection fraction recovery, which leads to worse prognosis, including recurrent events,…
Functional Assessment Using QFR for the Revascularization of Non-Culprit Lesions in AMI Patients
Nowadays, evidence from studies and meta-analyses has demonstrated the benefits of complete revascularization compared to culprit-vessel-only revascularization in patients with acute myocardial infarction (AMI). The identification and treatment of non-culprit lesions can be guided by conventional angiography, intracoronary imaging, or coronary physiology; the optimal modality, however, is still unclear. Quantitative flow ratio (QFR) is a…
EuroPCR 2024 | Complete revascularization affects clinical outcomes? REVIVED.BCIS2 Insights
Complete revascularization has shown in several studies and meta-analysis a benefit in mortality vs. incomplete revascularization. The REVIVED-BCIS looked at whether there were differences in mortality and hospitalization for cardiac failure in patients with ventricular function deterioration and viability when comparing coronary angioplasty(PCI) against optimal medical treatment. This study showed that PCI was not associated…
EuroPCR 2024 | DOCTORS-LM Trial: CTO Optimizes Stent Outcomes in Left Main Disease?
The aim of this randomized open study was to determine whether CTO guided left main percutaneous coronary intervention (PCI) is superior to fluoroscopy guided PCI, using fractional flow reserve (FFR) after stenting. The secondary outcomes were procedural success (successful implantation, malposition, edge dissection or stent collapse) and major adverse cardiovascular events (MACE) at one year.…
EuroPCR 2024 | Prognostic Value of MRR in STEMI: Group Analysis of Individual Patients
Despite primary angioplasty, many patients with ST elevation acute myocardial infarction with (STEMI) show evidence of microvascular dysfunction. This dysfunction can be characterized by two main factors: A new specific index has recently been identified to assess microcirculation called microvascular resistance reserve (MRR), which allows measuring vasodilatory capacity independent of the epicardium. The purpose of…
Acute Myocardial Infarction After TAVI: Retrospective Analysis of >200,000 Implants
Coronary artery disease is common among patients considered for transcatheter aortic valve implantation (TAVI). With the expansion of the indication for TAVI to a population with lower surgical risk, and therefore younger, there has been a gradual increase in the incidence of coronary events. However, there is limited data on treatment strategy and outcomes in…
ACC 2024 | REDUCE AMI: Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction
Most clinical trials have shown benefits of beta blockers after acute myocardial infraction, including patients with extensive AMI, and these were carried out in the era before AMI was diagnosed with biomarkers and prior to treatment with coronary angioplasty, use of antithrombotic agents and high intensity statins, and angiotensin-aldosterone system inhibitors. The aim of this…
ACC 2024 | DanGer-Shock Trial
Cardiogenic shock will develop in approximately 10% of patients with ST elevated acute MI (STEMI), and unfortunately, only half of these patients will survive. Researchers have been looking into the Impella system to manage this severe complication. It consists of an aortic transvalvular pump designed to deliver blood from the left ventricle into the systemic…
Virtual Flow Reserve (VFR): Virtual Physiological Test with OCT
Assessing intermediate coronary lesions with intracoronary physiology tests such as fractional flow reserve (FFR) or other non-hyperemic indices is considered the standard of care by both American and European societies. Likewise, intravascular imaging techniques (IVI), be it IVUS or optical coherence tomography (OCT), are of great use in assessing and guiding complex coronary lesions and…