Patients with acute myocardial infarction presenting lesions in multiple vessels is not associated with reduced infarct size in non-culprit lesions, even when functionally significant. Animal models suggest brief periods of ischemia in non-infarct territories (non-culprit) might protect culprit territory thanks to remote ischemic preconditioning. This pre-conditioning, according to this perspective, would reduce reperfusion injury and…
18/05 | Update on the treatment of acute coronary syndromes without ST segment elevation
Another virtual event open to the whole community! At SOLACI we want to continue promoting continuous medical education and, in that sense, to expand the development of interventional cardiology in Latin America. For this reason, we bring you a new educational proposal, this time an Update on the treatment of acute coronary syndromes without ST…
ST-Segment Elevation Infarction After TAVR: Problems in Every Aspect
For interventional cardiologists, treating an ST-segment elevation infarction in a patient with transcatheter aortic valve replacement (TAVR) is challenging in many ways. Longer door-to-balloon times and higher rates of primary angioplasty failure than in the general population are translated into very high short- and mid-term mortality. This multicenter study, recently published in JACC, included 118 patients…
Back to Basics: Ticagrelor Questioned and Clopidogrel in the Limelight
Yet another observational study has come to question the antiaggregation power of ticagrelor when it comes to death or MI reduction, pointing at its higher risk of bleeding vs. clopidogrel. This new analysis recently published in JAHA includes a large number of patients undergoing acute coronary syndrome (ACS) in the clinical practice. Ticagrelor has been…
Post MI Betablockers for Good?
Patients receiving optimal medical treatment after MI do not seem to benefit from betablockers in the long term, provided they do not present cardiac failure or systolic function deterioration. This study looked into the cardio protection effect of betablockers (BB) after long term follow up in stable patients with no cardiac failure and a history…
Biodegradable Polymer Myth Also Debunked for ACSs
During TCT 2020 a preview of the results of the comparison of drug-eluting stents (DES) with biodegradable-polymer vs. durable-polymer in patients with acute coronary syndrome (ACS) was presented. The fine print and the final paper for HOST-REDUCE-POLYTECH-ACS are now published, and they lower the expectations set on biodegradable polymers. In patients with ACS undergoing angioplasty, biodegradable-polymer…
MATRIX: Impact of Crossover from Radial Access to Femoral Access
The new MATRIX trial, recently published in JACC Interv., shows that an access-site crossover from radial to femoral access in patients with acute coronary syndrome cancels out the benefit provided by radial access as regards bleeding. However, there are no signs of comparative damage between successfully conducted radial or femoral access as a first attempt. …
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…
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…
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…
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…