The inclusion of fractional flow reserve (FFR) has changed how coronary interventions are treated. Current guidelines endorse its use in intermediate lesions with no evidence of ischemia in non-invasive studies in patients with multivessel disease. The original RIPCORD (Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain) study proposed…
ESC 2022 | Should We Follow-Up with Functional Testing in High-Risk Patients after CTA?
While the need for repeat cinecoronary angiography after transluminal coronary angioplasty (TCA) has decreased with the use of drug-eluting stents and improved medical treatment, patients still present ischemic recurrence or cardiovascular events at follow-up. Using a functional test at follow-up after TCA or myocardial revascularization (CMR) is a frequent practice in our context. This is…
Gender Differences and 10-Year Prognosis in STEMI
Coronary artery disease in women usually develops 10 years later than in men, and some evidence suggests women have higher mortality, especially when it comes to ST elevation MI (STEMI). Registries have shown higher mortality both in hospital and at one year follow up. In part, this difference is observed because of the gap in…
Aspiration Thrombectomy in Acute Coronary Syndrome: Is the Japanese Perspective a Strategy to Emulate?
Aspiration thrombectomy (AT) in patients with high thrombotic burden could pathophysiologically reduce thrombus burden, decrease distal embolization, reduce no-reflow phenomenon, and improve microvascular perfusion. However, its usefulness has not been shown in the large, randomized trials (TASTE and TOTAL) that compared routine use of AT in primary angioplasty in patients with ST-segment elevation acute coronary…
Angioplasty in Nonagenarians Is Increasingly Frequent: How Does It Evolve?
Currently, the number of nonagenarian patients undergoing angioplasty (whether elective, urgent or emergency) has increased. This population is linked to more comorbidities and has barely been included in most randomized studies or registries. As such, we do not have robust evidence on this group. Researchers conducted an analysis of the J-PCI OUTCOME Registry, in which…
Takotsubo Syndrome: Does Gender Impact Prognosis?
Takotsubo Syndrome (STT) is characterized by acute cardiac failure which can be reversed in many occasions, but is associated with morbidity and mortality at short and long term. It is most frequent among women, especially after menopause. However, gender differences have not been looked into when analyzing the evolution of this cardiomyopathy. This was an…
The Current Role of Thrombus Aspiration in Primary PCI
In general, thrombus aspiration in acute myocardial infarction (AMI) has not been shown beneficial by large studies. It could even be prejudicial, since it has been associated with stroke. However, there are certain scenarios where the presence of a significant number of these prevents us from reaching adequate TIMI flow 3, or is associated with…
When is the Ideal Timing for NSTE-ACS Percutaneous Intervention?
According to the European Society of Cardiology (ESC Guidelines 2021) an early invasive strategy is recommended (<24h) for high-risk patients with acute coronary syndrome with no ST elevation (NSTE-ACS), namely patients presenting a rise or fall in cardiac troponin, dynamic ST- or T-wave changes and GRACE risk score >140. Early intervention (<2h) is reserved for…
Should We Start Using OCT in Myocardial Infarction with Non-Obstructive Lesions?
In ST elevation MI, the common assessment methodology continues to the angiography; however, we all know it has certain limitations, especially when it comes to intermediate lesions or coronary dissections. Using imaging, especially high resolution such as OCT, has been looked into by some studies, but never randomized studies. The EROSION III is a randomized…
Coronary Angioplasty Evolution According to Syntax II: 5-Year Followup
It has been long since the SYNTAX (NEJM 2009) came out comparing percutaneous coronary intervention (PCI) against coronary artery bypass grafting (CABG). That emblematic study associated PCI with first generation drug eluting stents (Taxus) with increased major cardiac and cerebrovascular events (all-cause mortality, AMI, stroke, or any revascularization – MACCE) vs. CABG, at 5 years,…
Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus after ST-Segment Elevation Acute Coronary Syndrome
The incidence of left ventricular thrombosis (LVT) after anterior ST-segment elevation myocardial infarction (STEMI) ranges from 4% to 26%. This is associated with bad long-term evolution. In the past, triple-scheme therapy (vitamin K antagonist plus dual antiplatelet therapy) was recommended to prevent LVT, despite the lack of high-quality scientific evidence and an increase in the…