Heart disease is the most frequent cause of heart failure and, in some observational studies, transluminal coronary angioplasty (TCA) could help improve ventricular function. The only major randomized study to compare myocardial revascularization surgery (MRS) vs. medical treatment in patients with ventricular function impairment was the STICH study, which showed no difference at 5 years,...
Aspiration thrombectomy (AT) in patients with high thrombotic burden could pathophysiologically reduce thrombus burden, decrease distal embolization, reduce no-reflow phenomenon, and improve microvascular perfusion. However, its usefulness has not been shown in the large, randomized trials (TASTE and TOTAL) that compared routine use of AT in primary angioplasty in patients with ST-segment elevation acute coronary...
The prevalence of coronary lesions with bifurcation involvement is about 20% in patients undergoing coronary angiography (CTA). While provisional stenting is overall the most accepted technique, the 2018 myocardial revascularization guidelines recommend the 2-stent technique for complex bifurcation lesions, defined as side branch with lesion >5mm, distal reference diameter of the side branch ≥2.75, or...
The MASTER DAPT study analyzed the results of an abbreviated (mean 34 days) vs. conventional dual antiplatelet therapy (DAPT) in 4579 patients treated with angioplasty and a biodegradable polymer sirolimus-eluting stent. This recent publication on the same study analyzed the evolution within the same strategies of the subgroup of patients with complex angioplasty and compared...
Percutaneous treatment of coronary lesions affecting bifurcations has increased in recent decades. Coronary angioplasty (percutaneous coronary intervention, PCI) in these cases is associated with an increased rate of adverse events in patients with multivessel disease and left main coronary artery lesions. The SYNTAX score, which is a predictor of total mortality, is used to evaluate...
In general, thrombus aspiration in acute myocardial infarction (AMI) has not been shown beneficial by large studies. It could even be prejudicial, since it has been associated with stroke. However, there are certain scenarios where the presence of a significant number of these prevents us from reaching adequate TIMI flow 3, or is associated with...
In ST elevation MI, the common assessment methodology continues to the angiography; however, we all know it has certain limitations, especially when it comes to intermediate lesions or coronary dissections. Using imaging, especially high resolution such as OCT, has been looked into by some studies, but never randomized studies. The EROSION III is a randomized...
It has been long since the SYNTAX (NEJM 2009) came out comparing percutaneous coronary intervention (PCI) against coronary artery bypass grafting (CABG). That emblematic study associated PCI with first generation drug eluting stents (Taxus) with increased major cardiac and cerebrovascular events (all-cause mortality, AMI, stroke, or any revascularization – MACCE) vs. CABG, at 5 years,...
Intravascular ultrasound (IVUS) to guide drug-eluting stent (DES) implantation has been evaluated in several studies. Two randomized studies, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), have shown fewer repeat revascularizations compared with angiography-guided...
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for at least 50% of the HF population, with an increasing prevalence. Its diagnosis is based on the presence of typical symptoms and increased filling pressures, with an ejection fraction greater than 50%. In some cases—especially in the earlier stages of the disease—, laboratory and echocardiographic...