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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…
Visual Assessment for Non-Culprit Lesion Revascularization
There is evidence in favor of complete revascularization in the context of ST elevation MI with multivessel disease where primary PCI has been successful. However, the small print in these studies should be read carefully. Should revascularization be completed during index intervention, index hospitalization or after discharge? Should complete revascularization be based on visual assessment,…
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…
The Fellow’s Corner | 2nd Clinical Case: An Explosive Mission
Read the case presentation and join the conversation through the comments in this post! Case Introduction: An Explosive Mission! 56-year-old male patient Severe smoker Hypertension Dyslipidemia Sedentary lifestyle and stress A sibling suffered from an acute myocardial infraction Cardiac markers: Standard angina, intensity of 8-9/10, 3-to-4-h long, and dyspnea (on and off for the past…
ESC 2020 | New European Guidelines on Non-ST-Segment Elevation Acute Coronary Syndromes: What’s New?
The new European guidelines on NON-ST-segment elevation acute coronary syndromes (NSTE ACS) were presented virtually during the European Society of Cardiology 2020 Congress (ESC 2020) and published in Eur Heart J. This document includes news regarding a more agile infarction diagnosis, the use of non-invasive imaging, the simplification of anticoagulant therapy, infarction with normal coronary arteries,…
ESC 2020 | Ticagrelor Might Increase Bleeding and Mortality in the Elderly
Ticagrelor compared against clopidogrel produces more bleeding and also more deaths in patients over 80 recently undergoing acute myocardial infarction. Contrary to what has been observed in the general population, these data from the SWEDEHEART registry of post MI patients over 80, show higher bleeding and mortality rates with ticagrelor compared against clopidogrel. These findings…
ESC 2020 | Acute Myocardial Infarction and Anemia: Are Transfusions Necessary?
In anemic patients undergoing acute myocardial infarction, a restrictive transfusion strategy is as safe as a more liberal approach, in addition to saving costs. The cutoff value to decide for a transfusion would be < 8 g/dl hemoglobin. The REALITY outcomes were presented during the virtual ESC 2020 sessions. Anemia is relatively common in patients…
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. …