In patients at high risk of bleeding undergoing coronary stenting with a Xience stent, 1-to-3-month DAPT period resulted non-inferior to a 6-to-12-month period in terms of ischemic events, and this could be associated to a lower rate of major bleeding and lower stent thrombosis incidence. There is no longer an indication for conventional stents in…
ESC 2021 | RIPCORD-2: Routine FFR Evaluation of All Epicardial Vessels During Angiography
The predecessor of this research—RIPCORD, published in 2014—showed that using fractional flow reserve (FFR) changes the treatment strategy in about 25% of patients. That marked the rise of FFR. In fact, the DEFER, FAME, and FAME 2 studies offered results consistent with the original RIPCORD. In this research, authors tested the hypothesis of systematic use of…
ESC 2021 | MASTER DAPT: Dual Antiplatelet Therapy After Coronary Angioplasty in Patients at High Bleeding Risk
Courtesy of Dr. José Álvarez. In patients at high bleeding risk with drug-eluting stents, the duration of dual antiplatelet therapy has been subjected to ongoing review. Guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) suggest shortening this treatment to a maximum of three to six months (Class IIb).…
Post PCI Same Day Discharge: from Convenience to Need
Same day discharge following programed PCI with no complications has been a way for health centers to reduce costs that has resulted both safe and convenient for patients. With the arrival of the pandemic, reduced bed capacity, uninfected patient exposure and their potential contagion, and the always pressing need to reduce hospital costs have turned…
Large Differences between Focal and Diffuse Patterns of Stable CAD
PCI is far more successful at reducing ischemia when treating focal stable coronary artery disease (CAD). However, there were no differences in symptoms between both types of CAD. Physiological assessment with pressure wire pullback can be used to distinguish focal vs diffuse CAD, even though the relevance of this distinction has not been looked at…
How Bad is Malapposition? OCT Findings and Events
Most post-angioplasty findings with optical coherence tomography (OCT) were not associated with clinical adverse events. Exceptions were small intra-stent area, and significant malapposition. Suboptimal findings after angioplasty are very common (almost expected), although their clinical implications are uncertain. This registry—recently published in JACC—was developed in an attempt to answer these questions. The analysis included a…
Best Revascularization Strategy in Patients with Left Ventricular Deterioration
Multivessel disease associated to ventricular function deterioration is challenging in terms of risk, when choosing a revascularization strategy. According to this recent analysis of the SCAAR registry published in the European Heart Journal, long term followup seems to justify taking a higher risk initially, higher risk being myocardial revascularization surgery (CABG). The study looked at…
Bifurcations: A Long Return Journey
When it looked like the simplest techniques reach the best outcomes, along came the DK Crush studies. Indeed, after the COVIS III results in bifurcations, it appeared we had started to retrace our steps back to the foundation. The purpose of this study was to compare long term outcomes of the remarkably simple 1-stent strategy…
IVUS vs iFR for Left Main Decision Making
No decision on the coronary tree has more impact than left main intervention. This makes interventionists prone to over and underestimation of angiographic imaging. In other words, in real life we never report on angiograms showing moderate left main lesions. This reality should be looked into, since operating or intervening moderate left main lesions on…
A Headache for Cardiologists: Ischemia with Non-Obstructive Disease
Treating patients with functional stress test induced ischemia and non-obstructive coronary artery disease (INOCA) is complex and often frustrating. The multifactorial nature of this disease in addition to the complex physiopathological relationship between angina and ischemia turn these patients into a real headache for cardiologists. The CIAO-ISCHEMIA was recently published in Circulation and was designed…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…