Acute coronary syndromes articles


Ticagrelor: Yet Another Pleiotropic Effect?

Ticagrelor: Yet Another Pleiotropic Effect?

Studies in animals have shown ticagrelor offers better myocardial protection against reperfusion injury after ST elevation MI than clopidogrel.  This had to be tested in the clinical arena, which is the aim of this study (published in JACC Intv): to assess left ventricular remodeling after reperfusion.  The study included patients undergoing their first ST elevation

Beta Bloqueantes

Pleiotropic Effect of Metoprolol: Different From other B-blockers

The clinical practice guidelines recommend the early use of endovenous B-blockers in patients undergoing acute myocardial MI, taking for granted that all B-blockers have a similar class effect.  This experimental study might show metoprolol has other benefits that could make it superior to the rest of the B-blocker family.  Using an animal model with 45-minute

Desafíos pendientes con el acceso radial

Pending Challenges in Transradial Access

The recent SAFARI-STEMI study compared transradial and femoral access in patients with ST-segment elevation myocardial infarction, and no significant differences were found. These results have a sour taste for those in favor of transradial access, as they are convinced of its benefits and unwilling to go back to previous practices. This bitter taste is based

Nuevo dispositivo para tener mayor protección en la angioplastia carotídea

Axillary Access for Microaxial Ventricular Support Device Placement

There is little evidence in support of the axillary access for counterpulsation balloon insertion, but this evidence is null when it comes to microaxial ventricular support device placement (the Impella device family).  Clinical indication of short-term mechanical circulatory support devices has been on the rise. Many patients present suboptimal iliofemoral access or early mobilization is

El uso del ultrasonido intravascular en la angioplastia de tronco no protegido se asocia con mejores resultados en comparación con la angioplastia guiada solo por angiografía.

Intravascular Imaging: A Universal Approach for Angioplasty Optimization

Despite robust information supporting the use of intravascular imaging during coronary angioplasty, its use in clinical practice remains low. This paper proposes using an algorithm for decision-making throughout the procedure to promote increased intravascular imaging use. Regardless of the many technologies that have been incorporated into strut design struts and polymer type, the rate of

El acceso radial se asocia a menor mortalidad y menor sangrado en los pacientes cursando un infarto con supradesnivel del segmento ST que reciben angioplastia primaria.

The Transradial Approach Continues to Be the Best for Primary PCI

The transradial approach has been associated to lower mortality and bleeding rates in patients receiving primary PCI for ST elevation MI.  This had been called into question by the recent SAFARI-STEMI, but after including its outcomes in a new meta-analysis, the scales tilted slightly in favor of the transradial approach vs. the transfemoral.  The transradial

AHA 2020 | En gran medida, las imágenes encuentran la causa de MINOCA

AHA 2020 | In Most Cases, Imaging Can Determine What Causes MINOCA

Intravascular imaging with coronary optical coherence tomography (OCT) and magnetic resonance imaging allow for the identification of the cause of heart attack in 85% of women without coronary obstructions in angiography.  Myocardial infarction with non-obstructive coronary arteries (MINOCA) affects women disproportionately and we have considered these events as “false positives” for far too long. The

Antiplatelet Therapy in Elderly Population: Are the New P2Y12 Inhibitors Safe?

Should elderly patients stick to clopidogrel? The first large study on prasugrel showed an unacceptable increase of bleeding in elderly patients, suggesting the use of 5 mg (although the sample size was small, which hindered the determination of dose efficacy). Later, ticagrelor showed better efficacy than clopidogrel without apparent safety concerns. However, specific evidence on elderly

ticagrelor vs. aspirina

Ticagrelor or Prasugrel in ST Elevation MI

In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately.  Few studies have compared the efficacy and safety of the two most potent oral P2Y12 receptor inhibitors in


The Ten Commandments from the New Guidelines on Infarction Without ST-Segment Elevation

In 2020, the European Society of Cardiology guidelines for the management of patients with acute coronary syndromes without ST-segment elevation (Non-ST-Segment Elevation Myocardial Infarction, NSTEMI) were presented. This document went somewhat unnoticed in the context of the COVID-19 pandemic, so this seems a good time to review it and set out some practical “commandments” (something

Seguridad de combinar los nuevos anticoagulantes y la doble antiagregación

Is Loading NSTEMI with DAPT Convenient?

Pretreating non-ST elevation acute myocardial infarction (NSTEMI) patients with P2Y12 receptor inhibitors is not associated with improved clinical outcomes as it is to increased bleeding. NSTEMI patients are often treated with platelet antiaggregants in the daily clinical practice despite the lack of evidence for its benefits. This Swedish registry prospectively included 64857 patients undergoing NSTEMI