Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces…
Virtual ACC 2020 | Colchicine After Infarction: Good Results and Cost-Effectiveness
Low doses of colchicine reduce the risk of ischemic events after an acute myocardial infarction, according to the COLCOT trial, originally presented at the American Heart Association (AHA) 2019 Scientific Session and simultaneously published in the New England Journal of Medicine (NEJM). The new information featured at the virtual ACC 2020 refers to its cost-effectiveness. Colchicine…
16 Years of Superiority of Primary Angioplasty
The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial showed the 30-day superiority of patient transport to a primary angioplasty site vs. fibrinolysis at the hospital where the patient had been originally admitted. Those 30-day results became a landmark in the history of interventional cardiology. However, some suspected that such initial benefit could fade away over…
Virtual ACC 2020 | “Dangerous” Plaques by CT Effectively Predict Infarction
This post-hoc analysis of the SCOT-HEART shows low-attenuation plaque burden might successfully predict events. A greater number of low-attenuation plaques seems to be synonymous with greater risk which makes them better predictors than clinical scores, coronary calcification and stenosis degree. IVUS, CT and carotid ultrasound are the accepted tools to diagnose plaque burden and predict…
Virtual ACC 2020 | Myocardial Ischemia Induced by Sudden Mental Stress
Myocardial ischemia induced by sudden mental stress is associated with bad prognosis, especially in patients with a history of acute myocardial infarction according to this new study. This study, called MIMS-2, was meant to be presented at ACC 2020 together with the World Congress of Cardiology in Chicago, which was shut down because of the…
5 Years of FAST-MI: If Unable to Meet the Timeline, Thrombolization Is the Way to Go
A large proportion of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. These patients have poorer 5-year outcomes compared with those subjected to a pharmaco-invasive strategy. ST-segment elevation myocardial infarction guidelines recommend primary angioplasty as the strategy of choice within 120 min after a diagnostic electrocardiography. If that is not possible, thrombolytic…
Impella and Adverse Events
Long after AHA 2019 had presented observational studies showing adverse events associated to Impella, JAMA is finally publishing the official results including all charts and small print. The controversial analysis of the American registry had suggested worse outcomes with the intravascular microaxial left ventricular assist device Impella vs. the intra-aortic balloon pump in acute myocardial…
TAVR: Should Transradial Approach be the Second Access Site?
Courtesy of Dr. Carlos Fava. One of the major challenges we interventional cardiologists still face is access management. Reduced device diameter and improved transcatheter closure, together with increased operator experience, have significantly reduced vascular complications. However, we shouldn’t lose sight of the secondary access, usually transfemoral, generally used in case of primary access site related…
Mechanisms of Infarction in Coronary Arteries with Non-Significant Lesions
Infarctions with non-obstructive coronary artery disease, also known as MINOCA (myocardial infarction with nonobstructive coronary arteries), often present plaque rupture and thrombi associated with the affected myocardial territory. In these patients, optical coherence tomography (OCT) is of great value to identify the “culprit”. Even though atherosclerosis has been identified as a potential MINOCA mechanism, the…
Off-hours Primary PCI Still Have the Highest Mortality Rate?
According to this contemporary study, in the current organized STEMI network, patients admitted to a tertiary high-volume center for primary PCI are managed similarly and have similar prognosis regardless admission time. Several prior studies have shown primary PCI during off-hours (6 pm to 8 am) had worse outcomes vs. on-hour interventions (8 am to 6…
AHA 2019 | COMPLETE: Complete Revascularization Is Superior since It Treats Other Vulnerable Plaque
This COMPLETE sub-study using optical coherence tomography (OCT) showed the prevalence of vulnerable lesions other than the culprit which should provide a physiopathological explanation of the benefit of complete revascularization observed in the original study. STEMI patients with multivessel disease will benefit from complete revascularization in terms of reduced cardiovascular death and repeat MI according…