Transradial access should be the access of choice in patients with acute coronary syndrome, while bivalirudin has not shown any benefit for this population. The long-term follow-up from the MATRIX (Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial confirms the results at 30 days: transradial access is here to stay…
ESC 2018 | FUTURE: A Thorn in FFR and More Questions than Answers
As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of…
SOLACI-SOCIME 2018 | New Indications
Read articles on the main presentations of the first day of SOLACI-SOCIME 2018 Congress. See the presentation by Dr. Flavio Ribichini, entitled “New Indications”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
What Happens with Small Dissections and Imperfections Only Shown by OCT?
When we carry out an angioplasty guided by angiography alone, as we historically have, we are almost blind. Nowadays, optical coherence tomography (OCT) offers plenty of detail but also raises costs, procedure time, and contrast volume. The question that this study aimed to answer is whether becoming aware of all small defects and imperfections in…
The Dangerous Combination of Complex Angioplasty and High Bleeding Risk Seems to Have a Solution
The LEADERS FREE trial demonstrated that a polymer-free Biolimus A9-coated stent (BioFreedom™DCS; Biosensors Europe, Morges, Switzerland) is superior to a conventional stent (bare metal stent, BMS) in patients with high bleeding risk treated with only one month of dual antiplatelet therapy. Now, is this global study outcome applicable in cases of complex lesions with several…
Women in Cardiology: Still Underrepresented in a Field Full of Men
JAMA Cardiology dedicated a special with 4 articles on different issues women continue to face when considering this area of expertise, or when they have already chosen this fascinating field but still feel undervalued or discriminated compared with their male colleagues. One of the studies showed the career preferences of med school students. What trainees…
Left Main PCI: Despite Auspicious Long-Term Outcomes, Optimal Strategy Still under Discussion
Left main coronary artery bifurcation interventions have shown very good results at long term, especially with new generation DES. The one-stent strategy has seen better results than the two-stent strategy, according to this registry recently published in J Am Coll Cardiol Intv. However, how does this registry of the daily practice between the years 2002 and…
EXCEL Sub-Study: The Site of the Left Main Coronary Artery Lesion Does Not Alter History
The EXCEL study, originally presented at TCT 2016 and published simultaneously in the New England Journal of Medicine (NEJM), showed that angioplasty and surgery in patients with left main coronary artery disease have similar rates of mortality, infarction, and stroke at 3 years. This sub-study, recently published in J Am Coll Cardiol Intv, adds that the…
Noradrenaline seems superior to adrenaline in patients with cardiogenic shock
Noradrenaline (or norepinephrine) seems a safer choice than adrenaline (epinephrine) in patients undergoing acute myocardial infarction complicated with cardiogenic shock, according to the outcomes of this randomized study. Patients receiving adrenaline more often developed refractory shock, which led to early termination of this study. The administration of adrenaline was associated to over increased cardiac rate,…
Invasive Strategy in Frail Patients Is Safe
Courtesy of Dr. Carlos Fava. The current population of frail and elderly patients is increasing, and while non-ST-segment acute coronary syndrome (NSTEACS) guidelines recommend early invasive treatment, this group has been excluded from most studies on the subject. Current information on its efficacy is controversial but agrees with the notion that this is a higher-risk group…
Should Sex Be Taken into Account with Left Main Coronary Artery Revascularization?
The EXCEL trial did not find the sex of patients with left main coronary artery disease to be an independent predictor of adverse events after revascularization. However, women who underwent angioplasty had a trend towards worse outcomes, a finding that might be related to comorbidities and somewhat increased chances of peri-procedural complications. In its formal…