Patients who suffered their first coronary event before turning 40 years old have similar long-term mortality to those who experienced it even 10 years later, according to the YOUNG-MI Registry presented at the American College of Cardiology [ACC] 2019 Scientific Sessions. Secondary prevention must be used aggressively in both young and elder patients. Over more than…
ACC 2019 | SAFARI: Unexpectedly, Radial Approach Offers No Benefits In STEMI
This study was not able to show benefits in terms of mortality or bleeding when using radial vs. femoral approach in patients undergoing ST elevation myocardial Infarction. This small trial does not change things for “radialists” way past their learning curve who already feel confident with this technique. For them, there is no way back.…
Errata sheet regarding the publication “The Impella device questioned in the post-approval studies due to an increase of adverse events”
What was published in our website refers to the original publication by the FDA (Increased rate of mortality in patients receiving Abiomed Impella RP System – letter to health care providers) where, inadvertently, it was excluded from the title that the FDA communication referred exclusively to the Impella RP device. The Impella circulatory assistance system…
Optimal Revascularization Time in Transient STEMI
Patients admitted with transient ST elevation MI and later normalize completely (symptimos disappear before being treated) are those we normally say are “undergoing a non-ST elevation MI”. This is complex, because revascularization time remains nuclear, as is whether to treat them as STEMI or non-STEMI patients. The aim of this study was to determine the…
The Ten Commandments for the Fourth Universal Definition of Infarction
The Fourth Universal Definition of Myocardial Infarction is a document developed jointly by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF). The Fourth Definition was necessary for multiple reasons, including increasingly higher troponin sensitivity. While troponin obviously does not…
“Troponinitis” or “Troponinemia”: Terms that Trivialize Troponin Elevation Without a Specified Diagnosis
Troponin elevation is a common finding in acute patients admitted by an emergency service, even in the absence of an acute coronary event. There are patients in whom we simply cannot identify the origin of such troponin elevation. Initially, we relied on this marker as an exclusive marker of acute coronary syndrome. In consequence, many…
Acute Coronary Syndromes After TAVR: Frequent and Not All Undergo Coronary Angiography
Approximately 10% of patients who undergo transcatheter aortic valve replacement (TAVR) are readmitted for an acute coronary syndrome after a mean follow-up of 25 months. Male sex, prior coronary artery disease, and (surprisingly and hard to explain) nontransfemoral approach were independent predictors of acute coronary syndrome after TAVR, an event associated with high midterm mortality. While…
Can We Discontinue Betablockers after AMI?
Betablockers (BB) were the first drugs shown to effectively reduce events after acute MI. However, reperfusion and other secondary prevention drugs that came along after that have cast a shadow on betablockers’ original benefit. This study looked at betablocker discontinuation after acute MI in patients with no cardiac failure optimally treated with all recommended medication.…
AHA 2018 | More Evidence for the Impella Device, But Larger Trials Are Necessary
In this pilot study, unloading the left ventricle with the Impella CP circulatory support device and delaying angioplasty by about 30 minutes appeared to be feasible and safe in patients with acute myocardial infarction without cardiogenic shock. This work sought to test the hypothesis that the device reduces ischemia-reperfusion injury. The trial included 50 patients who had the…
AHA 2018 | Use of Balloon Counterpulsation According to IABP-SHOCK II Trial
Following up on the 30 day and one year effect, the IABP-SHOCK II trial long term outcomes showed there is not benefit to the use of intraaortic balloon counterpulsation in cardiogenic shock patients undergoing acute myocardial infarction. The only work in this group of patients with long term follow up is the SHOCK trial published in…
Cautious Administration of Supplemental 02, Especially in Acute Stroke or MI
Recent studies show the potential damaging effect of supplemental oxygen in the context of acute stroke and myocardial infarction. Experts now say that it should not be used in patients with >92% oxygen saturation. These guidelines have looked into the most recent studies, including the DET02X-AMI, which suggest supplemental oxygen therapy could increase mortality in…