A new diagnostic tool might change the classical abdominal aortic aneurysm (AAA) cutoff thresholds of 5.5 and 5 cm for men and women, respectively. The new ultrasound speckle tracking technology can study AAA wall motion in real time and has the potential to become the new standard for diagnostic and therapeutic decisions. This study looked…
Angioplasty in Aspirin-Free Stable Patients with Prasugrel: Innovation Continues
Potent P2Y12 receptor inhibitors, such as prasugrel and ticagrelor, have been tested mainly in a setting of acute coronary syndromes. There is little evidence on stable patients, particularly for prasugrel. Designing a study with that purpose seemed challenging enough, but adding aspirin discontinuation in patients without a particularly high bleeding risk took this research to…
The Ten Commandments from the New Guidelines on Infarction Without ST-Segment Elevation
In 2020, the European Society of Cardiology guidelines for the management of patients with acute coronary syndromes without ST-segment elevation (Non-ST-Segment Elevation Myocardial Infarction, NSTEMI) were presented. This document went somewhat unnoticed in the context of the COVID-19 pandemic, so this seems a good time to review it and set out some practical “commandments” (something…
Dual Layered for Dual Protection in Carotid PCI
At present, there is more than one dual layered stent in the market offering additional protection in carotid PCI. Therefore we saw fit to look at these devices to compare class benefits and find any specific differences. This study assessed the safety and efficacy of two dual layered mesh covered stents especially designed for carotid…
Number of Hours of Sleep and Risk of Stroke
Sleep duration (either short or long) affect the risk of stroke according to this recent analysis. We had visited a study published in JACC on the link between acute MI and sleep duration. This study appears to show similar results as regards sleep duration and stroke. The work prospectively included 79,881 men and women between…
Natural History of Asymptomatic COVID-19 Infection
Information on the natural history of asymptomatic infection with the new coronavirus (COVID-19) remains scarce. We are just beginning to understand what happens with patients with severe disease. The outbreak of COVID-19 on the cruise ship Diamond Princess provided a unique opportunity to study contacts and patients with asymptomatic infection within a closed population. This…
Efficacy of Remdesivir against COVID-19
This final report published in NEJM about the efficacy of remdesivir against COVID-19 infection vs placebo showed its superiority though only in soft end points, which does not seem to modify the course of this pandemic. Multiple drugs initially promising have been shown ineffective against the new virus. The case of hydroxychloroquine resulted paradigmatic: not…
Asymptomatic Severe Aortic Stenosis, When Should We Intervene?
Data from recent observational randomized studies suggest that most patients with asymptomatic severe aortic stenosis will eventually receive an indication for valve replacement. Mortality in this “asymptomatic” population is caused not only by sudden death, but also by cardiac death. Early intervention may prevent these deaths as a consequence of aortic stenosis symptoms. Researchers…
Conscious Versus General Anesthesia in TAVR
Patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) can safely undergo the procedure under conscious sedation. Conscious sedation has been adopted in clinical practice as a natural way of simplifying and conducting the procedure in the least invasive way possible. Currently, up to 50% of patients undergo TAVR under conscious sedation, but…
Is Loading NSTEMI with DAPT Convenient?
Pretreating non-ST elevation acute myocardial infarction (NSTEMI) patients with P2Y12 receptor inhibitors is not associated with improved clinical outcomes as it is to increased bleeding. NSTEMI patients are often treated with platelet antiaggregants in the daily clinical practice despite the lack of evidence for its benefits. This Swedish registry prospectively included 64857 patients undergoing NSTEMI…