Pooled data from the most important recently published studies (FAME 2, Compare-Acute, and DANAMI3-PRIMULTI) conclude that there is a significant difference in favor of fractional flow reserve (FFR) as regards hard endpoints. Coronary revascularization guided by FFR reduces the risk of death and infarction when compared with optimal medical treatment in patients with stable and…
EuroPCR 2018 | FAME 2: FFR Shows 5-Year Benefit for Hard Endpoints
After a 5-year follow-up, and for the first time, functional assessment with fractional flow reserve (FFR) showed clear benefit for a hard endpoint: acute myocardial infarction. Use of FFR in patients with stable coronary artery disease so as to identify hemodynamically significant lesions in order to restrict angioplasty treatment to them has long-term benefits compared…
Antithrombotics after Venous Stenting: Rather Different from Coronary Artery Stenting
Should the Antithrombotic/antiplatelet therapy following 10.0 by 60 mm stent implantation to the subclavian vein of a chronic kidney patient be the same as one following a 3.0 by 18 mm stent implantation to the second segment of the left anterior descending artery of this same patient? The daily practice of many interventional cardiologists performing…
EuroPCR 2018 | ORBITA: The Link Between Ischemia and Symptoms Is Still Not Entirely Understood
Invasive physiology tests used in the ORBITA trial could not predict which patients would benefit from angioplasty more than placebo (sham procedure) in terms of the trial’s primary endpoint, improvement in exercise time. These data were presented at EuroPCR 2018 and published simultaneously in Circulation. Results encourage debate over the importance of ischemia reduction with angioplasty…
EuroPCR 2018 | SYNTAX III REVOLUTION: Excellent Correlation Between Angiography and Computerized Tomography in Patients with Left Main and Multivessel Disease
In patients with left main or three-vessel coronary disease, heart team decisions on revascularization strategy (angioplasty or surgery) may be made based solely on noninvasive computerized tomography (CT) angiography, since there is great correlation between its results and those determined by conventional angiography. For the SYNTAX III REVOLUTION study, Dr. Serruys and his colleagues randomized…
EuroPCR 2018 | SCAAR Registry at 10 years: FFR improves decision making in the long term
The SCAAR registry aimed at showing the differences in mortality at very long term when using functional assessment of coronary lesions (with FFR or iFR) in patients with chronic stable angina. The study compared 3460 patients assessed with FFR/iFR against 21221 patients undergoing PCI based on angiography, between January 2005 and March 2015. As…
Is TAVR Durable Beyond 5 Years?
Courtesy of Dr. Carlos Fava. The benefits derived from transcatheter aortic valve replacement (TAVR) are clear and self-evident, and its progressively better outcomes are due to better patient selection, greater operator experience, and the development of new valves that enhance procedural safety and complexity. However, the question of durability remains a major unresolved issue, particularly now…
Post EVAR Contrast Enhanced Ultrasound Based Follow Up Reduces CT by 90%. Is It Safe Though?
This four-year retrospective analyzis has shown that contrast enhanced ultrasound based follow up protocol post endovascular aortic repair is safe and effective. Aneurysm related mortality, reintervention rate, sac retraction and endoleak detection resulted similar to that of CT based follow up protocols. In this study, doppler and enhanced contrast ultrasound were the main follow up…
Risk of Colonic Ischemia after Abdominal Aortic Aneurysm Repair
This is the largest and most recent analyzis to show colonic ischemia is more frequent after open abdominal aortic aneurysm repair (2.1% a 3.6%), compared against endovascular repair (0.5% a 1%), especially in elective patients. Most cases presented within the first 7 days. The evidence is not enough to determine the cause behind the different…
Maintaining Physical Activity After an Acute Myocardial Infarction Reduces Mortality
Performing a successful primary angioplasty and prescribing preventive medication without advising on the importance of keeping up with or taking up physical activity is a waste of one of our many opportunities to improve the quality of life of our patients and reduce mortality among them. If clinical cardiologists do not take over the patient,…