Courtesy of Dr. Alejandro Lakowsky, MTSAC (Full Member of the Argentine Society of Cardiology) The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin…
The Higher the LDL-C Level, the Greater the Benefit in Mortality with Aggressive Therapy
The latest studies seem to support higher baseline LDL-C levels would justify further intensifying and already aggressive drug strategy. A more aggressive hypolipidemic therapy would involve adding far more expensive new drugs that many specialists are reluctant to accept, in terms of their cost benefit ratio. The intensive therapy to lower LDL-C levels reduces cardiovascular…
Contrast Induced Kidney Injury, Infamous Problem with No Magical Solutions
In patients at high risk of developing kidney complications undergoing angiography, we did not observe benefits when administering intravenous sodium bicarbonate vs. saline, or oral N-acetylcysteine vs. placebo, as to the prevention of death, dialysis or persistent deterioration of kidney function at 90 days, or the prevention of contrast induced kidney failure. Many small studies…
Elderly Patients with ACS: Clopidogrel or Reduced-Dose Prasugrel?
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full…
ACC 2018 | Flu Vaccination Reduces Mortality in Heart Failure Hospitalizations
Heart failure patients vaccinated against influenza are at a significantly lower risk of dying, both during flu season and outside of it. Patients with heart failure vaccinated had a 48% lower risk of death during influenza season and a 21% lower risk during the rest of the year. Dr. Fukuta, lead investigator in this study,…
ACC 2018 | SECURE-PCI: High Dose of Statins pior PCI Could Help
Patients undergoing acute coronary syndrome (ACS) loaded with a high dose of statins prior diagnostic catheterization do not seem to benefit from this strategy. However, when looking at those undergoing PCI alone (excluding all patients who had received surgery or medical treatment), the benefit appears as a reduction of combined major events. The benefit of atorvastatin loading…
ACC 2018 | SMART-DATE: 6 Month DAPT Results Suboptimal in ACS
This study compared 6 vs 12 or more months of dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) receiving contemporary DES, and it did not find differences in combined endpoint. However, looking at primary endpoint components separately, there were more infarctions in patients with a short DAPT scheme that we cannot ignore. Prolonging antiaggregation…
ACC 2018 | TREAT: Ticagrelor + Fibrinolytics’ Effect on Bleeding
Ticagrelor seems as safe as clopidogrel in patients undergoing ST elevation MI treated with fibrinolytics, at least in terms of TIMI major bleeding at 30 days. Longer follow up will help determine whether there are differences in efficacy or safety issues, as stated by the presenter Otavio Berwanger. This study was presented at ACC 2018 scientific sessions…
Dual Antiplatelet Therapy: Less Is More for Elderly Patients
A recent meta-analysis that will be published soon in JACC Intv offers evidence of benefit derived from short-term dual antiplatelet therapy for elderly patients. This is a patient group that has always been excluded from the major trials, while remaining one of the most challenging subgroups in which to balance bleeding and ischemic risks. The…
Transulnar Access: Another Ace Up Our Sleeve Before Transfemoral Access
Transulnar access can be as safe and effective as transradial access, and it is a particularly good alternative for the preservation of radial artery patency or when such vessel presents a difficult anatomy. This new meta-analysis that will be published soon in Catheter Cardiovasc Interv showed a relatively high failure rate for that access, but…
New Study Shows Ticagrelor + Aspirin Reduce Events Rate
Just when we were starting to understand how long dual antiplatelet therapy should be for our patients, JACC publishes this study where ticagrelor combined with aspirin significantly reduces relative and absolute events rate at long term, especially in patients with multivessel disease. The PEGASUS-TIMI 54 assessed the long-term benefits of two different doses of ticagrelor (60 mg or…