Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. This document was presented a few days ago at the European Society of Cardiology (ESC) Congress in Munich and simultaneously…
Direct Stenting vs. Conventional Angioplasty and Their Interaction with Thrombus Aspiration
The rates of direct stenting are higher among patients randomized to thrombus aspiration. The rates of clinical events and myocardial reperfusion did not differ significantly between a direct stenting strategy vs. predilation and stenting, and no interaction was observed as regards thrombus aspiration. Several preliminary studies have emerged from the hypothesis that a direct stenting…
OCT Provides Hints About the Physiopathology Behind Very Late Stent Thrombosis
Neoatherosclerosis was frequently observed in patients who experienced very late stent thrombosis, particularly those with drug-eluting stents. In-stent plaque rupture was the most common cause of thrombosis and it usually occurred in cases in which the original procedure had been carried out while the patient was undergoing an acute myocardial infarction. Macrophage infiltration can be…
Report on Cardiovascular Death in Mexico Within the SOLACI-SOCIME 2018 Congress
How can you know if you are having an infarction? What is the rate of cardiovascular death in Mexico? What are the possible solutions to this problem? José Luis Leiva Pons, SOLACI president, and Jorge Cortés Lawrenz, SOLACI-SOCIME 2018 Congress chair, analyzed the situation of cardiovascular health in Mexico during the SOLACI-SOCIME 2018 Congress that…
ESC 2018 | CULPRIT-SHOCK: 1-Year Results Continue to Support Treatment of the Culprit Artery Only
Increases in the rates of revascularization and heart failure do not justify the early mortality advantage shown by treatment of the culprit artery only in patients with acute myocardial infarction and cardiogenic shock. The 1-year follow-up of the CULPRIT-SHOCK trial reinforces the idea of only treating the culprit artery, with an option for revascularization of…
ESC 2018 | MATRIX: 1-Year Superiority of Transradial Access
Transradial access should be the access of choice in patients with acute coronary syndrome, while bivalirudin has not shown any benefit for this population. The long-term follow-up from the MATRIX (Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial confirms the results at 30 days: transradial access is here to stay…
Noradrenaline seems superior to adrenaline in patients with cardiogenic shock
Noradrenaline (or norepinephrine) seems a safer choice than adrenaline (epinephrine) in patients undergoing acute myocardial infarction complicated with cardiogenic shock, according to the outcomes of this randomized study. Patients receiving adrenaline more often developed refractory shock, which led to early termination of this study. The administration of adrenaline was associated to over increased cardiac rate,…
Invasive Strategy in Frail Patients Is Safe
Courtesy of Dr. Carlos Fava. The current population of frail and elderly patients is increasing, and while non-ST-segment acute coronary syndrome (NSTEACS) guidelines recommend early invasive treatment, this group has been excluded from most studies on the subject. Current information on its efficacy is controversial but agrees with the notion that this is a higher-risk group…
Cardiovascular Events During World Cup Soccer, an Old Article Worth Remembering
Is it possible for a soccer match to trigger an infarction? Is it possible for the stress derived from watching our national team play to trigger a cardiovascular event? Many might think that these are exaggerations. However, not only is it possible, but it has been proved beyond the shadow of a doubt for some…
EuroPCR 2018 | TRANSIENT trial: What is the best timing for TRANSIENT STEMI revascularization?
The objective of this study was to determine the best time to revascularize a patient who is undergoing an acute coronary syndrome (ACS) with transient ST segment elevation. This population hovers around 15% of STEMI patients. The question is whether to reduce infarction area (or potential reinfarction) with an immediate intervention, or to delay intervention…
EuroPCR 2018 | 2nd and 3rd-Generation DES for Bifurcation Lesions: Nothing New Under the Sun
This study aimed to assess the outcome of Culotte stenting with newer-generation drug-eluting stents (DES) in Medina 1, 1, 1 bifurcation lesions. The 2nd-generation device used was permanent-polymer everolimus-eluting stent Xience, a device for which there is comparatively plenty of evidence available. Alternatively, the 3rd-generation stent used was thin-strut abluminal bioresorbable-polymer everolimus-eluting stent SYNERGY. Patients with…