The goal of this study was to assess all available revascularization strategies for patients undergoing ST elevation acute myocardial infarction and multivessel disease. Among the strategies to treat this group of patients, there were: culprit vessel intervention only, culprit vessel intervention and, in case of success, multivessel intervention, culprit vessel intervention with staged revascularization,…
Thrombus Aspiration during Primary PCI Does Not Improve Clinical Outcomes
Thrombus aspiration during primary PCI in ST elevation MI has been extensively used; however, recent studies have questioned its efficacy and safety. This meta-analysis looked into individual patient data to determine the benefit and safety of thrombus aspiration during primary PCI. It included all randomized and controlled studies assessing manual thrombectomy vs. conventional…
Edge Restenosis with Everolimus Eluting Stents: a few Predictors
Stent edge restenosis continues to be a weakness of drug eluting stents (DES). The aim of this study was to determine its predictors using optical coherence tomography (OCT). The study retrospectively analyzed 319 patients receiving OCT immediately after everolimus eluting stent implantation (EES) looking into the immediate outcome, and follow up angiography at 9…
Severity of Lesions Assessed by FFR in Coronary Disease: Is It Associated with Major Events?
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…
Post NSTEMI Invasive Strategy Timing
The aim of this meta-analysis, which included all randomized studies carried out to date, was to compare an early invasive strategy vs. a delayed invasive strategy in patients undergoing non ST elevation myocardial infarction (NSTEMI). Even though there is no doubt invasive strategies reduce events rate such as death and re-infarction in NSTEMI patients,…
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…
Ticagrelor vs. Prasugel: Similar Safety and Efficacy in Primary Angioplasty
No randomized head-to-head study comparing the efficacy and safety of ticagrelor and prasugrel has been carried out in the last 7 years since these newer P2Y12 inhibitors first showed a higher efficacy relative to clopidogrel. This study was designed to compare the efficacy and safety of prasugrel and ticagrelor in patients with acute myocardial infarction…
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…