Courtesy of Dr. Santiago F. Coroleu. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel after percutaneous coronary intervention (PCI) reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). However, the lack of information to accurately predict the occurrence of each event in out-of-hospital patients under…
Closure Devices vs. Manual Compression
Courtesy of Dr. Guillermo Migliaro. Post PCI major bleeding has been associated with short term mortality in acute coronary syndromes (ACS). Even though studies have shown the transradial approach is safer than the femoral, especially in high risk subgroups ─ mainly STEMI patients ─ the femoral access site continues to be widely used. …
Pre-TAVI Mitral Regurgitation Is Associated with Higher Mortality
Courtesy of Dr. Carlos Fava. This study sought to analyze the clinical impact and the level of improvement of mitral regurgitation (MR) in patients who receive a transcatheter aortic valve replacement (TAVR), and to find potential candidates for double valve repair with percutaneous techniques. Of 1.110 patients included, 177 (15.9%) suffered from severe pre-TAVR mitral…
DES in primary PCI: The Best Option?
Courtesy of Dr. Brian Nazareth Donato. The relative safety of drug-eluting stents (DES) and conventional bare-metal stents (BMS) in primary angioplasty (percutaneous coronary intervention, PCI) in patients with ST elevation myocardial infarction (STEMI) is still subject of debate. A search was carried out using Medline, CENTRAL, EMBASE, TCTMD and Cardiosource. There were 9673 patients included,…
Stem Cells: A New Alternative for Refractory Angina?
Courtesy of Dr. Agustín Vecchia. Recent investigations and certain randomized trials suggest that the administration of CD34+ stem cells to patients with refractory angina improves exercise tolerance and decreases angina frequency. The following is a phase 3, randomized, double-blind multicenter trial comparing three groups of patients: active treatment through intramyocardial administration of CD34+ stem cells (autologous, purified), standard of care…
Sex Specific Outcomes: Women after TAVI
Courtesy of Dr. Carlos Fava. The benefits of transcatheter aortic valve implantation (TAVI) have been widely shown, but there is no evidence on sex-specific outcomes. Some studies have shown lower mortality and better evolution of the ventricular function in women, yet with more bleeding and stroke; however, it remains unclear. This study included 1,019 patients…
No Extra Benefit for Combined Use of Bivalirudin and Transradial Approach
The aim of this meta-analyzis was to study the relation between bivalirudin and access site in patients undergoing acute coronary syndrome (ACS). Both bivalirudin and the transradial access site are strategies aiming at reducing bleeding complication in patients with ACS undergoing invasive approaches. The interaction of both strategies and the potential benefits of their combined use…
BVS: Comparable to Second-Generation DES in Complex Lesions
A center carrying out a mid- to long-term follow-up of the performance of everolimus-eluting bioresorbable scaffolds (Absorb) observed that this new device has an acceptable rate of major cardiovascular events, when compared to second-generation drug-eluting stents. Furthermore, although the population was complex and non-selected, no cases of early thrombosis were reported. This study enrolled 249 patients…
Low BMI Is a Predictor of Death for TAVI
Courtesy of Dr. Carlos Fava. Body mass index (BMI) has always played an important role in heart surgery. However, there is little evidence on BMI effects on TAVI. This study included 491 patients, which were divided according to BMI into: low (<20 Kg/m2 ) normal (20-24.9 Kg/m2 ) overweight (25-30 Kg/m2 ) obese…
Non-Compliant Balloons Improve Bifurcation Outcomes
Courtesy of Dr. Carlos Fava. The provisional approach is the standard strategy to treat bifurcations, but it might cause dissection of the ostium, a serious complication of the side branch. The use of non-compliant balloons (NCB) ensures uniform, constant, and controlled expansion along balloon length, reducing the risk of dissection. The COBIS II registry enrolled…