The most common cause of myocardial necrosis in patient undergoing COVID-19 infection is microthrombi. These microthrombi resulted quite different in composition vs. thrombi obtained from COVID-19 negative patients and thrombi obtained from infected patients with ACS. Myocardial injury is common in patients hospitalized for COVID-19 and has worse prognosis. Regardless its frequency, the mechanism and…
AAS vs Warfarin in Low Risk TAVR
We are still discussing the adequate antithrombotic scheme after transcatheter aortic valve replacement (TAVR). Additionally, we are treating a much wider array of patients ranging from low risk to inoperable. And there is yet one more important point: hypo-attenuated leaflet thickening diagnosed by CT. We are still unaware of the impact they have on device…
Medical Therapy Optimization Achieved Prior Clinical Trial
12 weeks prior the ORBITA randomization, medical therapy optimization of all antianginal medication was achieved. Most importantly, optimization was well tolerated by all patients, with scarce adverse effects leading to therapy termination. In clinical practice, there is skepticism towards achieving maximal dosage with a cost-effective therapy, good tolerance, adherence, and no drug-drug interaction. The ORBITA…
Net Clinical Benefit of Long-Term Ticagrelor
Ticagrelor reduces ischemic risk in patients with a history of acute myocardial infarction, but it increases the risk of bleeding. Keeping a delicate balance is paramount when prescribing long-term ticagrelor to patients with a history of infarction. The PEGASUS-TIMI 54 study randomized 21,162 patients with a history of infarction on a 1:1:1 ratio: some received ticagrelor…
Regression of High-Risk Plaque with Lifestyle Changes
Diet and lifestyle intervention in addition to optimal medical therapy can slow down plaque building and even reduce plaque volume compared against optimal medical treatment (OTM) alone. Diet and lifestyle intervention are amongst the most important strategies to manage coronary artery disease. However, its direct impact on atherosclerosis remains unclear. Atherosclerosis plaque building is associated…
Might Alcohol Consumption Reduce Stroke?
A J shaped curve illustrating the link between alcohol consumption and ischemic stroke has been reported, suggesting that a certain amount of alcohol would be beneficial compared against absolute abstinence and excessive consumption. In order to shed some light on this matter, this study looked at alcohol consumption patterns and their effect on stroke in…
Reducing Chronic Inflammation in Atherosclerosis with an Old Drug
Inflammation plays a crucial role in atherosclerosis progression. Recently, the COLCOT study has shown the benefits of colchicine in cardiovascular events. This good old drug has an inflammatory effect which attenuates the NLRP3 cascade. This explains its effect on uric acid crystals in gout, which might be the same on atherosclerosis cholesterol crystals. This study…
Ticagrelor: Yet Another Pleiotropic Effect?
Studies in animals have shown ticagrelor offers better myocardial protection against reperfusion injury after ST elevation MI than clopidogrel. This had to be tested in the clinical arena, which is the aim of this study (published in JACC Intv): to assess left ventricular remodeling after reperfusion. The study included patients undergoing their first ST elevation…
The Most Read Articles of January in Interventional Cardiology
01- New Valvular Heart Disease Guidelines with Key TAVI and Mitral Regurgitation Updates Valvular heart disease management guidelines were updated last week by the AHA and the ACC. Read more HERE 02- High Risk Anatomy Challenges ISCHEMIA Outcomes According to this recent analysis published in JAHA, patients with stable Ischemic heart disease and high-risk anatomy benefit from revascularization…
Should We Discontinue Anticoagulation Before TAVR?
Against what common sense dictates, continuing oral anticoagulation pre- and post- transcatheter aortic valve replacement (TAVR) is safe, according to this article soon to be published in JACC Interventions. There was no increase in hemorrhagic or vascular complications and, paradoxically, those who continued using anticoagulant agents received fewer transfusions that those who did not. A…
Latest News on AHA/ACC Primary Prevention Guidelines
Most cardiovascular diseases and mortality come down to 4 years of unhealthy habits (smoking, poor diet, obesity and sedentarism) and 3 major risk factors (cholesterol, hypertension, and diabetes). Ideal cardiovascular health, defined as absence or control of these 7 factors, is far less frequent than we might believe. It is estimated that 87% of the…