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…
Complete Revascularization Improves Long-Term Prognosis in Acute Coronary Syndromes
Going beyond the culprit artery during angioplasty was associated with lower mortality, although this was a cohort study that should be confirmed through randomized trials. According to this new observational study, patients experiencing non-ST-segment elevation myocardial infarction with multivessel disease seem to benefit from complete revascularization during initial angioplasty. This study, published online before…
iFR Assessment of Intermediate Aortic Stenosis Lesions Consolidates
Once a big void that prevented us from effectively assessing functional compromise, intermediate aortic stenosis has made us treat many lesions “just in case”, to save us what would be a complicated procedure, had a valve been placed. Auspiciously, some light has been shed by several, most welcome, studies simultaneously published in J Am Coll…
ICELAND MI: Unrecognized MI Have Similar Prognosis to Recognized MI
At 10-year follow-up, unrecognized or silent MIs have similar mortality to clinically recognized MI and, even though this does not justify routine screening, these findings call for more aggressive prevention. Unrecognized MI, detected by MRI, is associated to long term mortality risk similar to that of recognized MI; therefore, these patients have higher risk…
Safety of Lesion Deferral with iFR or FFR in Both Stable and Acute Patients
Overall, deferral of lesion revascularization is equally safe with both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), with a low rate of events of about 4%. Lesions were more frequently deferred when iFR (as opposed to FFR) was used for functional assessment. Among patients with deferred lesions, acute patients experienced significantly more events…
TCT 2018 | LRP: Infrared Technology for the Detection of Vulnerable Patients and Plaques
Despite optimal medical treatment and modification of risk factors, patients may spend long periods without symptoms and then experience acute coronary syndrome without any prior indication that may allow us to predict the time of occurrence. This is why the possibility of detecting patients with vulnerable plaques and who are at higher risk is very…