A new ISCHEMIA analysis has shown its outcomes are highly dependent on MI definition. The original conclusion had shown a significant difference between invasive and conservative strategies using the most sensible definition of MI: troponin elevation. When looking at events using MI definition as troponin elevation, we will see the conservative treatment reduces primary end…
High Risk Anatomy Challenges ISCHEMIA Outcomes
According to this recent analysis published in JAHA, patients with stable Ischemic heart disease and high-risk anatomy benefit from revascularization at long term vs. the conservative treatment. This goes against the study presented by Reynolds H et al at AHA 2020. Dr. Reynold’s was a sub-study of the ISCHEMIA trial which had observed that even…
Axillary Access for Microaxial Ventricular Support Device Placement
There is little evidence in support of the axillary access for counterpulsation balloon insertion, but this evidence is null when it comes to microaxial ventricular support device placement (the Impella device family). Clinical indication of short-term mechanical circulatory support devices has been on the rise. Many patients present suboptimal iliofemoral access or early mobilization is…
Intravascular Imaging: A Universal Approach for Angioplasty Optimization
Despite robust information supporting the use of intravascular imaging during coronary angioplasty, its use in clinical practice remains low. This paper proposes using an algorithm for decision-making throughout the procedure to promote increased intravascular imaging use. Regardless of the many technologies that have been incorporated into strut design struts and polymer type, the rate of…
Global FFR as Prognosis in CAD Patients without Ischemia
Global fractional flow reserve (FFR) results from adding up FFR values of the three major coronary arteries. This figure represents the physiological atherosclerosis burden and can predict events at long term in patients without stenosis leading to ischemia. This recent study published in JAHA looked at major cardiovascular events (death, infarction and revascularization) at 5…
Plaque Volume Over Stenosis Degree
Paradigms are bound to eventually change. After years blinded by stenosis degree, plaque volume has proven to be a better predictor of cardiovascular events and death. Thus, patients with similar degrees of atherosclerosis burden have a similar prognosis, regardless of their lesions being obstructive or not. The aim of this work was to assess whether…
Low-Carb Diet and Coronary Artery Calcium Progression
People on low carb diets since a young age present increased risk of coronary artery calcium progression, particularly when carbs are replaced by animal protein and fat. This study included CARDIA participants (Coronary Artery Risk Development in Young Adults) receiving a CT scan between the years 2000 and 2001 for calcium scoring, who also completed…
AHA 2020 | Effect of Evolocumab in Complex Coronary Revascularization
Evolocumab, a PCSK9 inhibitor, has shown significant reduction of complex coronary disease requiring revascularization (be it PCI or CABG). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and could eventually reduce the risk of coronary revascularization, especially complex revascularization. The FOURIER study randomized 27564 patients with stable CAD already on statins to evolocumab…
AHA 2020 | Clopidogrel Resists as the Best Option in Elective Patients
High risk patients undergoing elective PCI treated with a more potent antiplatelet scheme (ticagrelor) vs. the classic clopidogrel do not see a benefit in protection against periprocedural events and instead see increased costs and minor bleeding rate. These are the outcomes of the ALPHEUS study presented at AHA 2020 simultaneously published in the Lancet. Ticagrelor…
AHA 2020 | The More Operators “Listen” to FFR, the Lower the Risk
When operators decide to proceed with PCI despite a negative FFR (fairly frequent in the daily practice) outcomes at 5 years are far worse. This information comes from a large Canadian register presented at AHA 2020 Scientific Sessions, simultaneously published in JAMA. PCI to a non-ischemic lesion results in increased events risk at long term,…
Mental Stress, Frontal Lobe Activation and Chest Pain
Historically, we have believed that mental stress might induce chest pain as a response to increased levels of catecholamines and consequently increased product (by 100%), just as it happens with physical stress. This innovative study published in Circ Cardiovasc Imaging shows the activation of specific areas in the brain is independently associated with chest pain…