The higher rate of restenosis in the diabetic population is historic and has been reproduced in all studies and with all kinds of stents, but it was only after the FREEDOM trial when we found out about the higher infarction rate with PCI compared to surgery. This is why 50% of patients undergoing CABG are diabetic. Apart from the above…
Risk of Thrombosis and Bleeding with Peripheral Artery Disease and Concomitants
Peripheral artery disease (PAD) is no longer a systemic manifestation of atherosclerosis. In fact, 2 in 3 people with PAD have concomitant heart disease, and 1 in 3 people has concomitant PAD. To understand the real dimension of this problem, we should know that PAD patients have 60% more risk of acute myocardial infarction…
SOLACI CACI 2017 | BVS: from clinical evidence to daily practice
Read articles on the main presentations of the first day of SOLACI-CACI 2017 Congress. See the presentation by Dr. Stephen Ellis entitled “BVS: from clinical evidence to daily practice”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
MRS vs. DES: Which one is associated with better long-term quality of life?
The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be…
PCI Mortality and Volume in One Center: Associated?
The relationship between procedure volume and prognosis after a percutaneous coronary intervention remains unclear. Intuitively, we tend to think the larger the volume, the better the results and, consequently, the lower the mortality. But when analyzing the literature, we find studies for and against this thesis. Evidence does support the idea that volume improves outcomes…
Glycemic control and risk of repeat revascularization
The association between glycemic control after coronary angioplasty and outcomes of the latter is controversial in many studies. We have come to think that the risk lies in suffering from diabetes, as if it was an unmodifiable factor. We have also come to believe that glycemic control can impact microvascular complications while it cannot do…
New generation DES present better results in vein grafts than older DES and BMS
There is little information comparing contemporary drug eluting stents (DES) against bare metal stents (BMS), for PCI in saphenous vein grafts in patients receiving (CABG). This study aimed to assess clinical outcomes after PCI in saphenous vein grafts in patients receiving BMS, first generation DES, and new generation DES between 2006 and 2013. The study…
BVS: Controvertial Scaffold
Courtesy of Dr. Agustín Vecchia. The advent of resorbable vascular scaffolds (BVS) generated high expectations among interventionists because of its potential advantages over bare metal stents. However, when comparing BVS against the Xience stent, we observed an increased rate of events associated to the first device, to their detriment. Among the reasons behind this poor…
Less volume, more mortality: should we be concerned?
Courtesy of Dr. Agustín Vecchia. In general, guidelines recommend a number of procedures a year for operators to maintain a reasonably safe level of proficiency. Even though this number is arbitrary and operators’ aptitude varies considerable, more than one publication has found an inverse correlation between procedure volume and outcomes. This study incorporated 10,496 operators…
Same-day discharge after coronary angioplasty is increasingly popular but still not the gold standard
The length of hospital stay after elective coronary angioplasty varies significantly among operators and hospitals, according to a recent survey of interventional cardiologists in the United States (US), Canada, and the United Kingdom (UK), published in Catherization and Cardiovascular Interventions. While same-day discharge is a routine proceeding in the UK, most interventional cardiologists surveyed mentioned…
DEFINE FLAIR and IFR SWEDEHEART: Safety in Revascularization Based on FFR and iFR in Both Stable and ACS Patients
The safety of physiology-based coronary revascularisation has been supported by evidence for years now. DEFER (1998-2001) was one of the first related studies. However, major changes in device and medical treatment safety and efficacy have taken place since then. This could affect clinical results, particularly as regards acute coronary syndromes (ACS). Several studies have cast…