The Shock Trial, the one that set revascularization as the standard strategy to treat all STEMI and cardiogenic shock lesions, had not been discussed for nearly 20 years. The CULPRIT-SHOCK was presented at TCT 2017 (and also in NEJM), and again this one study changed the standard completely, since we went back to treating only…
Estimating the Risk of Infection for Healthcare Personnel
Roughly one out of every 100 healthcare workers at hospitals receiving COVID-19 patients become infected. Statistics are not uniform for all corners of earth, and they do not indicate that being on the front line necessarily entails higher risk. A large analysis conducted in the initial epicenter of the COVID-19 pandemic (Wuhan, China) showed that 110…
Compare-Acute Sub-Study: Natural History of Non-Culprit Lesions in MI
The aim of this study was to determine the prognostic value of fractional flow reserve (FFR) of non-culprit lesions in STEMI patients. We analyzed data of all Compare-Acute patients (Comparison Between FFR Guided Revascularization Versus Conventional Strategy in Acute STEMI Patients With MVD) after PCI, from lesions assessed with FFR and treated medically. The treating…
Bleeding and Cardiogenic Shock: An “Unholy Alliance”?
Courtesy of Dr. Carlos Fava. Mortality in acute myocardial infarction (MI) with cardiogenic shock (CS) has been reduced over the past two decades. This has been possible thanks to early angioplasty, greater operator (and overall medical team) experience, new antiplatelet therapies, and ventricular assist devices, which have also been somewhat relevant in this setting. However, in…
Priorities in the Cath Lab to Escape COVID-19 Tsunami
The pandemic tsunami of COVID-19 has hit all cath lab services, especially those performing primary PCI. Passively waiting for the first patient suspected of infection only to improvise in the early hours means heading for disaster. Several scientific societies have published recommendations, but not based on clear data. It seems pertinent to bear in mind…
Covid-19 and Unaccounted Collateral Damage
Dr Metzler and collaborators carried out a retrospective search to find out the impact of the Covid-19 pandemic on diagnosis and treatment of acute coronary syndromes during March 2020 in Austria. Basically, they tried to account for the collateral damage we all imagine, but no government reports. During March we observed a significant drop in…
Frailty and Bleeding: Impact on Aortic Valve Replacement
Courtesy of Dr. Carlos Fava. We are well aware that both transcatheter aortic valve replacement (TAVR) and surgical valve replacement (SAVR) generate bleeding (15% to 22% for TAVR and 22% to 44% for SAVR). Frail patients constitute a particular group. These have not yet been assessed as to the real risk they run and mortality…
Leaflet Thickening and Immobility in Evolut Low Risk
Leaflet thickening and immobility caused by thrombosis have been reported for both surgical and transcatheter bioprostheses. This phenomenon is diagnosed through hypoattenuation, thickening, and lack of motion, as observed through computed tomography (CT) imaging. The incidence and, especially, the clinical implications of this phenomenon remain unclear, but they are of great interest, particularly in a…
Special Articles on COVID-19
Myocardial Injury for COVID-19 Even in Young Patients with Mild Symptoms Most young COVID-19 patients not requiring hospitalization showed abnormal cardiac magnetic resonance imaging (CMR) beyond two months after diagnosis. Read more HERE Infarction, Stroke and Aortic Emergency Syndromes in the Shadow of the Pandemic The coronavirus pandemic has had a negative impact on the…
More Data from the EXCEL and More Controversy
A thorough statistical analysis of the EXCEL has quite definitely shown that the likelihood of death, MI or stoke, including total mortality, is higher with PCI compared against CABG. The Bayesian analysis estimated a 3.3% difference in mortality, superior in the PCI arm, with 99% probability that EXCEL total mortality was indeed increased with PCI…