In patients with coronary disease, the prognosis depends on the extent and reversibility of myocardial ischemia. Whether the outcome also depends on the severity of stenosis as determined by fractional flow reserve (FFR) has not been studied yet. This study investigates the relationship between fractional flow reserve values and vessel-related events. Major adverse cardiovascular…
Myocardial Revascularization Surgery: One or Two Internal-Thoracic-Artery Grafts?
The use of both internal thoracic (mammary) arteries for myocardial revascularization surgery might improve long-term outcomes, compared with the use of a single internal thoracic artery. Patients scheduled for myocardial revascularization surgery (only multivessel procedures; combined valve procedures were excluded) were randomized to receive a single internal-thoracic-artery graft (internal thoracic artery for the anterior…
Right vs. Left Transradial Access for Coronary Procedures
Courtesy of Dr. Guillermo Migliaro. Coronary angiography and angioplasty via transradial approach are associated with a significant reduction in access site complications, compared with transfemoral and transbrachial access. Moreover, a significant reduction in mortality has been reported for procedures performed via transradial approach vs. transfemoral approach in primary angioplasty. There is a limited number…
Coronary Lesions After TAVR: Severity May Be Modified
Courtesy of Dr. Carlos Fava. Between 40% and 70% of patients undergoing transcatheter aortic valve replacement (TAVR) present coronary lesions. The fact that aortic stenosis affects how blockages act, and that, after stenosis correction, hemodynamic compromise for those same lesions may vary, has been consistently proven. Its management has not been determined yet. The study…
Post PCI High Sensitivity Troponin Elevation: No Prognostic Value
The prognostic value of high sensitivity troponin elevation after elective PCI in patients with or without elevated baseline values remains unclear. The aim of this study was to measure the prognostic value of post elective procedure high sensitivity troponin and to determine whether this may be influenced by baselines TnT values. The study…
FUTURE: Mortality Increase in the FFR Arm, Real or Casual?
The FUTURE study, testing the utility of functional revascularization by measuring the fractional flow reserve (FFR), was halted early by its safety committee due to an increased mortality rate at 1 year among patients guided by FFR. In this unexpected unprecedented outcome, 17 patients in the FFR-guided group died at a year of follow-up, compared with 7 patients…
Is Angioplasty at Centers Without Surgical Backup Safe?
Performing coronary angioplasties at hospitals without surgical backup seems to be safe for a wide variety of patients, from those presenting ST-segment elevation myocardial infarction to those undergoing elective procedures. This work responds to a long-running debate over whether centers without on-site surgery capabilities in case of complications can be considered as referral centers…
Non-Cardiac Surgery with Incomplete Revascularization, Associated to Events
This study presented at the American Heart Association Scientific Sessions 2016 and simultaneously published in the Journal of the American College of Cardiology, showed incomplete revascularization is associated with an increased risk of adverse cardiac events, particularly infarction, in patients that must later receive non-cardiac surgery. Patients with incomplete revascularization (defined as a ≥ 50% left…
Women: More Prone to Lower Coronary Flow Reserve
Compared to men, women have less chances of developing obstructive coronary artery disease (CAD), but this new study suggests they are more prone to have lower coronary flow reserve, which is also a risk factor. Evidently, ischemic cardiomyopathy entails far more than assessing and treating plaque burden in epicardial arteries. In women, the most…
IVUS vs. Angiography in New-Generation Drug-Eluting Stents Preimplantation
Courtesy of Dr. Guillermo Migliaro. The latest 2011 American College of Cardiology (ACC) guideline states that “coronary intravascular ultrasonography (IVUS) may be considered for guidance of coronary stent implantation, particularly in cases of left main coronary artery stenting (Class IIB, Level of Evidence: B).” This has been long debated with no clear winners. This analysis provides new information…
Strict LDL Monitoring Helps Reduce Plaque Volume
The aim of this study was to explore the relationship between temporal changes in coronary plaque volume and the intensity of lipid lowering treatments using coronary computed tomography (CTA). Coronary computed tomography has acceptable accuracy in terms of quantitative measurement on plaque volume, enough to identify changes in volume according to LDL levels. …