With an approximate incidence of 0.05% to 0.25%, post-acute myocardial infarction (AMI) mitral valve failure caused by papillary muscle rupture is not exactly common. However, it is associated to high mortality rate, ranging between 36% and 80%. Current guidelines recommend surgical treatment, but more often than not surgery involves prohibitive or extremely high risk, with…
5 Year Evolution of PCI vs CABG in Large Randomized Studies on Acute and Chronic Coronary Syndrome
Left main lesions in acute coronary syndrome (ACS) represent a major risk and, at present, the best revascularization strategy is a matter of debate. Though many studies and registries have excluded this group of patients, there is data on the pros and cons of both percutaneous coronary intervention (PCI) and cardiac artery bypass graft (CABG). …
Invasive vs Conservative Treatment in Patients with Spontaneous Coronary Artery Dissection
The prevalence of spontaneous coronary artery dissection (SCAD) is around 4% of acute coronary syndromes (ACS). Even though the current guidelines recommend a conservative approach, as long as it is clinically viable, it remain unclear whether there are benefits to percutaneous coronary intervention (PCI) as an initial approach, to prevent disease progression and adverse events.…
Association Between Radial Wall Strain (RWS) and Risk of Acute Myocardial Infarction
Despite major advances in secondary prevention and reperfusion strategies, acute myocardial infarction (AMI) still causes morbidity and mortality. A significant portion of acute events arise from mild to moderate lesions identified months to years before the index event. Early detection of lesions at higher risk of progression and rupture may allow for more targeted treatment…
Differences in Events Between MINOCA and MIOCA Patients: Contemporaneous Cohort Analysis
Sex-related MINOCA and MIOCA differences. Several international guidelines recommend invasive treatment after diagnosing an acute coronary syndrome (ACS). The first studies that described acute myocardial infarction (AMI) without obstructive epicardial coronary disease reported a 10% incidence rate. Based on this significant prevalence, it was recommended that this diagnosis be classified as MINOCA for patients who…
ACC 2023 | Ultrasensitive Troponin I Monitoring with a Transdermal Wrist Device
Over the years, early diagnosis of myocardial ischemia has ranged from 0-to-3-h protocols to abbreviated guidelines with point-of-care cardiac marker dosing. However, specific devices for this have not yet been validated. The Sengupta P. et al. research group evaluated the feasibility of using an infrared measuring device—placed on the wrist of patients—compared with blood sampling…
Left Main Revascularization: 12 Year Registry in Canada
The current indication for severe left main lesion continues to be coronary artery bypass graft surgery (CABG) but percutaneous coronary intervention (PCI) has come far in this territory thanks to increasing operator experienced and the use of IVUS during procedures. At present, left main disease have a Class IIa indication in the American guidelines when…
Rivaroxaban in Acute Coronary Syndrome
Acute coronary syndromes (ACS) involve high mortality risk, especially ST elevation ACS. Their treatment is based on reperfusion, dual antiplatelet therapy (DAPT) and anticoagulation, with enoxaparin (1 mg/kg twice a day) as the preferred anticoagulant according to the contemporary guidelines. 2.5 mg or 5 mg doses of rivaroxaban might be valid alternative treatments for this…
Intracoronary Brachytherapy for Drug-Eluting Stent Restenosis
3 Year Clinical Outcome Analysis and Failure Predictors in the Use of Intracoronary Brachytherapy for Drug-Eluting Stent Restenosis In-stent restenosis (ISR) has been one of the greatest obstacles standing in the way of long term patency in percutaneous coronary interventions. However, the use of drug eluting stents (DES) and their development has helped reduce ISR…
Plaque Erosion with No Stenting in Acute Coronary Syndrome: Are There Event Predictors to Avoid This Strategy?
Event predictors in patients with plaque erosion and no stenting. A third of all acute coronary syndrome (ACS) cases are caused by plaque erosion. In the initial EROSION study, it was shown that patients with plaque erosion (as evidenced by OCT, with stenosis <70%, TIMI III flow, and asymptomatic) were stabilized without stent implantation (no…
Monotherapy with P2Y12 in Complex Interventions: Less and Less Risky
Monotherapy in patients with complex angioplasty: meta-analysis of 5 randomized studies. Even though prolonged dual antiplatelet therapy (DAPT) might reduce the risk of important ischemic complications, this reduction will come at the expense of a significant increase of bleeding risk, which makes us reassess the cost benefit ratio of this decision. This is also why…