Cardiac complications are among the most frequent in patients undergoing carotid endarterectomy for asymptomatic lesions. This excess of cardiac events in patients with no neurological symptoms of carotid stenosis is essential to balance the risk/benefit ratio of carotid endarterectomy. A routine cardiology consultation prior surgery could reduce perioperative infarction rate, general complications and even mortality. …
Outflow Tract Calcification and the Best Valve in This Context
Moderate or severe left ventricle outflow tract calcification increases the risk of annulus rupture, residual aortic regurgitation and the need for a second valve. This recent study analyzed the performance of different contemporary prosthetic valves in patients with this particular anatomy. Since the early days of transcatheter aortic valve replacement (TAVR) outflow tract calcification has…
ESC 2020 | Ticagrelor Might Increase Bleeding and Mortality in the Elderly
Ticagrelor compared against clopidogrel produces more bleeding and also more deaths in patients over 80 recently undergoing acute myocardial infarction. Contrary to what has been observed in the general population, these data from the SWEDEHEART registry of post MI patients over 80, show higher bleeding and mortality rates with ticagrelor compared against clopidogrel. These findings…
ESC 2020 | Antihypertensive Therapy Reduces Events Regardless of BP Levels or Risk
Antihypertensive therapy reduces the risk of cardiovascular events even in patients with no history of heart disease or with normal baseline blood pressure (BP). This fuels a long-running debate about thresholds for hypertension diagnosis (which may or may not exist). Beyond that, the higher the baseline BP, the better the benefit. The decision to prescribe…
ESC 2020 | Rivaroxaban Might Reduce Cardiac Cerebral and Peripheral Events
Adding rivaroxaban to the standard treatment might reduce events incidence in lower limbs, heart, and brain, in patients with peripheral vascular disease undergoing revascularization. These new data resulted from the analysis of the VOYAGER PAD subgroups and were presented at the virtual ESC 2020. The COMPASS study had reached similar conclusions using 2.5 mg rivaroxaban…
ESC 2020 | Acute Myocardial Infarction and Anemia: Are Transfusions Necessary?
In anemic patients undergoing acute myocardial infarction, a restrictive transfusion strategy is as safe as a more liberal approach, in addition to saving costs. The cutoff value to decide for a transfusion would be < 8 g/dl hemoglobin. The REALITY outcomes were presented during the virtual ESC 2020 sessions. Anemia is relatively common in patients…
ESC 2020 | More Evidence on Colchicine for Chronic Ischemic Heart Disease
According to this new study, colchicine offers some benefit to patients with chronic ischemic heart disease. Similar to COLCOT, this is the second large randomized study with results confirming the inflammatory hypothesis. Colchicine taken at a daily dose of 0.5 mg reduces cardiovascular events in patients with stable coronary disease, according to data from the LoDoCo2…
ESC 2020 | 2020 Atrial Fibrillation Guidelines: News on Diagnosis, Classification, and Care
New guidelines for the diagnosis and treatment of atrial fibrillation (AF) were released at the 2020 European Society of Cardiology (ESC) virtual congress. This document incorporates several findings from the latest clinical trials, but also represents a great shift in terms of how physicians from different specialties should classify and manage arrhythmia after confirming the…
ESC 2020 | Revascularization Strategies: Ventricular Dysfunction Might Tilt the Scales
Patients included in the ISCHEMIA trial who had a history of cardiac failure or ventricular function deterioration will benefit from revascularization vs. optimal medical treatment. This is a pre-specified analysis of the paradigmatic ISCHEMIA trial. The ISCHEMIA was published in March 2020 in NEJM and went somewhat unnoticed due to the COVID-19 pandemic. At the…
ESC 2020 | Dapagliflozin in Kidney Failure: The Drug Continues to Conquer Other Territories
The DAPA-CKD trial has shown dapagliflozin, a SGLT2 receptor inhibitor, improves function, and reduces cardiovascular events and mortality. The latter is true regardless being or not diabetic. Patients with chronic kidney failure randomized to dapagliflozin saw improved kidney function, reduced cardiovascular events and increased survival rate. Primary end point, a combination of glomerular filtration deterioration…