The higher the age, the greater the benefit of ticagrelor monotherapy vs. dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome. This post hoc sub-analysis of the TICO study goes along the same lines as the TWILIGHT study (which we recently discussed), given that age is the most common reason for considering that a…
AHA 2021 | RAPID CABG: Safety of Early Surgical Intervention in Acute Coronary Syndrome
Suspending ticagrelor a couple of days before surgery was non-inferior to waiting 5-6 days in terms of bleeding in patients with acute coronary syndrome (ACS) requiring myocardial revascularization surgery. Patients who waited longer had more ischemic events and longer hospitalizations. Current American guidelines recommend waiting at least 5 days before operating on patients with ACS who…
TCT 2021 | iFR-SWEDEHEART: 5 Years to Trust FFR Is Equivalent to iFR
The 5-year followup of the iFR-SWEDEHEART has confirmed the safety and efficacy of using either FFR or iFR to guide PCI in intermediate lesions. The iFR-SWEDEHEART initial outcomes together with the DEFINE-FLAIR outcomes had started the debate around these two measuring strategies. The FFR requires adenosine, which results costly in addition to causing adverse events,…
First Guidelines Focused Specifically on Chest Pain Management
Many years of developing and waiting have led us to the latest guidelines published by ACC/AHA together with other societies. This is the first document exclusively dedicated to the assessment and diagnosis of acute chest pain. In this regard, we can safely say this is no mere update of a previous set of guidelines, but…
STOPDAPT-2 ACS: One-Month DAPT NOT Enough in acute patients
One-month dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) did not reach the safety and efficacy results observed in the general population of the original trial STOPDAPT-2. The STOPDAPT-2 ACS compared one-month DAPT followed by clopidogrel monotherapy for one year vs. one-year DAPT after PCI. Initially, the study enrolled mostly stable patients…
Non-Culprit Vessel Angioplasty in the Elderly: Choosing the Right Cases Is Important
This large analysis found no benefit at a 1-year follow-up to angioplasty of non-culprit vessels in elderly patients admitted with ST-segment elevation myocardial infarction. The COMPLETE study was presented at the European Society of Cardiology 2019 Congress (and simultaneously published in NEJM) with evidence that seemed to leave no doubt regarding this issue. However, new…
FLOWER-MI Sub-Studies Coming Out Generate More Questions about FFR
The FLOWER-MI (presented simultaneously at ACC 2021 and NEJM) hit FFR hard. Its outcomes showed that STEMI patients presenting other non-culprit lesions did not benefit from FFR guided revascularization vs PCI. As it happens with most large studies with unexpected results in the general population, the sub-studies that follow select better samples and, as a…
ESC 2021 | COVERT-MI: Colchicine Attempts to Reduce Infarct Size
Colchicine does not offer protection against myocardial injury in ST-segment elevation myocardial infarction when administered during reperfusion and in the following five days, according to the randomized study COVERT-MI. It could even generate signs of damage with 3x the amount of thrombi in the ventricle. The results presented at the European Society of Cardiology 2021…
ESC 2021 | ISAR-REACT 5: Prasugrel Superior to Ticagrelor in ACS across Kidney Function Spectrum
When we have to choose between two potent P2Y12 receptor inhibitors for a patient undergoing ACS with a planned invasive strategy, kidney function should not interfere in this decision. The main findings of this study were that prasugrel has lower risk of all cause death, MI or stroke, and also had a similar risk of…
ESC 2021 | TOMAHAWK: Angiography After Resuscitated Patients from Out-Of-Hospital Cardiac Arrest with No ST Elevation.
What triggered this study was a long unanswered question: should patients successfully resuscitated from an out-of-hospital cardiac arrest presenting a non-STEMI ECG be immediately taken to the cath lab? In response to this question the TOMAHAWK randomized 554 out-of-hospital resuscitated patients without electrocardiographic evidence of ST-segment elevation patients to immediate angiography (n=281) vs intensive care…
Dual Antiaggregation De-Escalation: A New Paradigm?
De-escalating dual antiaggregation could be the most effective strategy after acute coronary syndrome seeing as it prevents bleeding and cut down costs with no increase of ischemic events. Balancing the effects of dual antiaggregation therapy (DAPT) in the era of potent P2Y12 inhibitors has become the cornerstone of acute coronary syndrome (ACS) management. This meta-analysis…