Courtesy of Dr. Carlos Fava. Severe left main coronary artery (LMCA) lesions have a bad prognosis in coronary disease. In that scenario, current guidelines recommend surgery as the treatment of choice. However, due to the current development of second-generation drug-eluting stents (DES) and greater operator expertise, left main coronary artery angioplasty appears as a valid alternative…
Burnout Syndrome among Cardiologists
For the first time, the American College of Cardiology (ACC) has carried out a survey on this phenomenon, and more than 25% of Cardiologists have reported the characteristic symptoms of burnout. This syndrome is known, among other things, for chronic fatigue at work, low self-esteem and difficulty to focus, associated with stress and aggressiveness. These findings should be taken…
Clinical and Economic Costs Compete in the De-Escalation of Antiplatelet Therapy
Patients undergoing primary angioplasty for ST-segment elevation acute myocardial infarction have similar clinical outcomes at 1 year regardless of whether they are treated with ticagrelor or prasugrel, according the PRAGUE-18 study. This new substudy adds an interesting detail: patients who switched from prasugrel and ticagrelor to clopidogrel, citing economic reasons for the “de-escalation” of therapy, were…
Aspirin During Noncardiac Surgery: Only in Patients with Prior Angioplasty
A new analysis from the POISE-2 study suggests that aspirin should not be withheld prior to noncardiac surgery in patients with a history of coronary angioplasty, even if their coronary procedure occurred several years earlier. Patients with a history of coronary angioplasty who need cardiac surgery are more likely to benefit from continued aspirin therapy,…
Endovascular Strategy Seems Superior against Surgery in Ruptured Aneurysms
Compared to surgery, endovascular repair of ruptured abdominal aorta aneurysms has better clinical results, survival and quality of life for patients (in addition to being cost-effective), according to mid-term outcomes of the IMPROVE study, recently published in the British Medical Journal. Even though the initial outcomes had not shown differences between both strategies in terms of…
Closure of Patent Foramen Ovale for the Treatment of Migraine
Migraine is one of the more frequent disabling disorders worldwide, but its physiopathology remains unclear. Since migraine is quite heterogeneous, individual therapies may not be effective for all patients. We still lack strategies to help us predict which patient subset might respond best to certain therapies. Read also: “Amplatzer and Figulla Devices Prove to Be…
TAVR in Pure Aortic Regurgitation: New Devices, New Outcomes
Pure aortic regurgitation has historically been considered a contraindication for transcatheter aortic valve replacement (TAVR) due to the absence of calcification and subsequent device anchoring problems it poses. Initial reports on first-generation self-expanding valves for the treatment of pure regurgitation were somewhat discouraging, but devices evolved, adding repositioning capacity, different external skirts (pericardial, PET, urethane,…
Cardiac Damage: Should we start to assess it?
Courtesy of Dr. Carlos Fava. The current recommendation for aortic valve replacement is based on stenosis severity based on valvular criteria (mean transvalvular gradient, peak aortic velocity and valve index area) and the presence of symptoms, in addition to comorbidities, mainly for risk stratification. However, ventricular damage and/or its effect on cardiovascular hemodynamics are not regarded…
iFR in Nonculprit Lesions: Measurement Timing May Change History
During primary angioplasty, it is not uncommon to see several other lesions in coronary arteries. Current guidelines advise against the treatment of these lesions in the same primary angioplasty procedure, although there is evidence supporting such a course of action that may warrant changes in these recommendations. The functional assessment of these nonculprit lesions may…
Clopidogrel or Ticagrelor in Patients with Acute Coronary Syndrome Treated with New-Generation DES: CHANGE DAPT
Courtesy of Dr. Pablo Baglioni. This is a prospective observational study with a 1-year follow-up analyzing 2062 patients with acute coronary syndrome (ACS) who have been treated with coronary angioplasty using new-generation drug-eluting stents (DES). Patients were included between December 21, 2012 and August 25, 2015. On May, 2014, due to changes in international guidelines, clopidogrel…