Patients with documented spasm to the coronary arteries present increased risk of myocardial infarction (MI) and repeat angiography, while patients with microvascular spasm are associated to recurrent angina. Globally, the prognosis of all these patients continues to be favourable, even though acetylcholine testing might help distinguish one-another. Coronary spasm shows in up to 60% of…
Computerized Tomography as First Coronary Study?
According to this new document recently published in JACC, a computerized tomography (CT) coronary angiography should be the first study done to diagnose a stable coronary artery disease. A multidisciplinary group of experts recommends using computerized tomography as first-line diagnosis in stable patients. According to these professionals, guidelines should be updated soon. Given the accruing…
Ticagrelor to Improve Venous Graft Patency
Saphenous vein graft patency is one of CABG’s “Achilles heals”, especially after the ARTS trial came out showing bilateral internal mammary artery grafting was not superior to simple internal mammary artery grafting. Antiaggregation more potent than aspirin might prolong venous graft patency in cases when the available techniques will fail to improve poor outcomes. Previous…
ESC 2020 | More Evidence on Colchicine for Chronic Ischemic Heart Disease
According to this new study, colchicine offers some benefit to patients with chronic ischemic heart disease. Similar to COLCOT, this is the second large randomized study with results confirming the inflammatory hypothesis. Colchicine taken at a daily dose of 0.5 mg reduces cardiovascular events in patients with stable coronary disease, according to data from the LoDoCo2…
ESC 2020 | Revascularization Strategies: Ventricular Dysfunction Might Tilt the Scales
Patients included in the ISCHEMIA trial who had a history of cardiac failure or ventricular function deterioration will benefit from revascularization vs. optimal medical treatment. This is a pre-specified analysis of the paradigmatic ISCHEMIA trial. The ISCHEMIA was published in March 2020 in NEJM and went somewhat unnoticed due to the COVID-19 pandemic. At the…
ESC 2020 | At Long Term, Diabetic Patients Benefit from Surgery
Data of this “real world” study have confirmed that diabetic patients with multivessel disease will benefit from coronary artery bypass grafting (CABG). According to Dr. Douglas S. Lee, main author of this study, the evidence is fairly conclusive, enough to recommend CABG as first option in this particular subgroup of patients similar to FREEDOM patients. …
ESC 2020 | Post PCI Trimetazidine: No Adverse Events or Great Benefits
Trimetazidine in addition to optimal medical therapy in patients undergoing coronary PCI does not change events rate at long term. The ATPCI study was presented at ESC 2020 and simultaneously published in the Lancet. This study randomized coronary PCI patients with stable or acute NSTEMI coronary syndromes to trimetazidine vs. placebo. What is the rationale…
Can Aspirin Use Be Interrupted After Angioplasty?
Aspirin discontinuation 1 to 3 months after angioplasty with continued P2Y12 inhibitor therapy reduces the bleeding risk without an increase in thrombotic events. This is also the case for patients admitted with acute coronary syndrome. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has been shown to reduce the risk of major events compared with…
IVUS in Every Step of Complex Angioplasty
Complex angioplasties require not only experience and patience but also technology. Imaging–guided pre-dilation, stent sizing, and post-dilation reduced the cardiovascular events after a 3-year follow-up in patients who received drug-eluting stents in complex angioplasties. This paper, recently published in JACC Interventions, compared the 3-year outcome of the complex angioplasty optimization technique with intravascular imaging to…
Randomized Evidence on the Helpfulness of Yoga for Cardiac Rehabilitation
This work brings us evidence that yoga-based cardiac rehabilitation improves how patients feel about their health and reduces the time it takes them to resume the activities they could perform before experiencing an infarction. That is important information with impeccable timing. The COVID-19 pandemic has interrupted most of the assistance we offer to cardiovascular patients,…
Quantitative Angiography that Estimates Shear Stress and Predicts Events
Shear stress has been incorporated to our jargon to identify this turbulent flow in certain places of the arterial tree (curves, bifurcations, etc.) that make these sectors more prone to plaque buildup. Seeing we often use the original term, no Spanish translation has been coined; we all refer to this phenomenon as shear stress and…