Elevated blood pressure variability was associated with a wide range of subclinical structural changes in the brain. These structural changes could be the mechanisms explaining a higher incidence of dementia and stroke. This study included 2348 participants age ≥55 years in a prospective cohort. Blood pressure was measured in each visit since 1990, and since 2005 all…
TAVR: Balloon-Expandable or Self-Expanding Valves, Which Is the Answer?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has shown benefit and is currently moving towards low-risk patients, as well as bicuspid aortic valves and (to a lower extent) aortic regurgitation. However, we must ponder on which valve should be used on each patient: balloon-expandable (BE) or self-expanding (SE) valve? They represent different technologies…
SPARCL: Highly Effective Prevention of New Events with Atorvastatin after a Stroke
In patients with recent stroke or transient ischemic attack, the total number of vascular events prevented by atorvastatin was twice as high as the number of prevented index events. In other words, the power of atorvastatin in secondary prevention is far superior to primary prevention. This gigantic reduction, both in index and recurrent events, gives…
Temporary Emergency Guidelines for Infarction During the Pandemic
Several United States societies (the American Heart Association [AHA] among them) have answered the question of many physicians in the front lines: what is the ideal strategy for the treatment of ST segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic? This document intends to ensure that patients with STEMI continue to receive adequate, proven…
Antiaggregation vs. Anticoagulation after Peripheral PCI
The truth is this question has no clear answer and what with do with peripheral stenting is transfer the evidence we have on coronary stenting, given the lack of standards and poor reporting on antithrombotic therapy outcomes in randomized studies on endovascular intervention. Heterogeneity is worse when it comes to venous territory. Some time ago…
Should We Finalize TAVR with Atrial Pacing in Some Patients?
Courtesy of Dr. Carlos Fava. The benefits of transcatheter aortic valve replacement (TAVR) are undoubtedly clear, but implantation is performed near the atrioventricular (AV) node, the bundle of His, and the left bundle branch. Consequently, permanent pacemaker implantation (PPI) after TAVR or surgical aortic valve replacement becomes necessary. While researchers have recently developed strategies to reduce…
Post-MI Colchicine: Cost-Effective with Good Results
Low colchicine doses reduce the risk of post-AMI ischemic events according to the COLCOT trial, originally presented at AHA 2019 scientific sessions, and simultaneously published in NEJM. The new information delivered at the virtual ACC 2020 addresses its cost-effectiveness. Colchicine is an anti-inflammatory drug indicated in the treatment of gout and pericarditis, but its price…
Common Femoral Artery Endarterectomy Plus Angioplasty in Critical Ischemia
This prospective study analyzed patients with critical lower limb ischemia (due to complex, multiple lesions in several places) who were treated uniformly with common femoral artery endarterectomy combined with angioplasty to improve inflow and/or outflow. This hybrid treatment, which must be carried out by a team, can be greatly beneficial for this high-risk patient group…
Malignancies and Aortic Stenosis: Is TAVR Warranted?
This meta-analysis tells us that patients with active malignancies and severe aortic stenosis have a good evolution after transcatheter aortic valve replacement (TAVR), except for a higher rate of pacemaker implantation in the general population. These patients must not be limited to respite care only, at least as far as aortic stenosis is concerned. Short-term…
Aligning Prosthetic Valves to Native Commissures: The Secret to Coronary Artery Obstruction?
Preventing coronary artery obstruction during transcatheter aortic valve replacement (TAVR) continues to be a challenge. There are techniques to prevent (or at least reduce) this from happening, which could be catastrophic. However, they all somehow fall into palliative care, that is, they will merely provide relief, rather than a cure. Commissure overlapping and the resulting…