A new ISCHEMIA analysis has shown its outcomes are highly dependent on MI definition. The original conclusion had shown a significant difference between invasive and conservative strategies using the most sensible definition of MI: troponin elevation. When looking at events using MI definition as troponin elevation, we will see the conservative treatment reduces primary end...
According to this recent analysis published in JAHA, patients with stable Ischemic heart disease and high-risk anatomy benefit from revascularization at long term vs. the conservative treatment. This goes against the study presented by Reynolds H et al at AHA 2020. Dr. Reynold’s was a sub-study of the ISCHEMIA trial which had observed that even...
In this selection, we summarize for you the most important scientific news of 2020 in the field of structural heart disease. 01- Virtual ACC 2020 | COAPT: Better Quality of Life Translates into Harder End-Points After transcatheter mitral valve repair with MitraClip, the COAPT patients saw improved quality of life, better survival rate and fewer hospitalizations...
Evolocumab, a PCSK9 inhibitor, has shown significant reduction of complex coronary disease requiring revascularization (be it PCI or CABG). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and could eventually reduce the risk of coronary revascularization, especially complex revascularization. The FOURIER study randomized 27564 patients with stable CAD already on statins to evolocumab...
01- ESC 2020 | New European Guidelines on Non-ST-Segment Elevation Acute Coronary Syndromes: What’s New? The new European guidelines on NON-ST-segment elevation acute coronary syndromes (NSTE ACS) were presented virtually during the European Society of Cardiology 2020 Congress (ESC 2020) and published in Eur Heart J. Read more HERE 02- Ticagrelor to Improve Venous Graft Patency Saphenous...
Saphenous vein graft patency is one of CABG’s “Achilles heals”, especially after the ARTS trial came out showing bilateral internal mammary artery grafting was not superior to simple internal mammary artery grafting. Antiaggregation more potent than aspirin might prolong venous graft patency in cases when the available techniques will fail to improve poor outcomes. Previous...
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...
Data of this “real world” study have confirmed that diabetic patients with multivessel disease will benefit from coronary artery bypass grafting (CABG). According to Dr. Douglas S. Lee, main author of this study, the evidence is fairly conclusive, enough to recommend CABG as first option in this particular subgroup of patients similar to FREEDOM patients. ...
Courtesy of Dr. Carlos Fava. Surgical aortic valve replacement with bioprosthesis has proved its benefits, but it fails after 10 to 15 years. Transcatheter aortic valve replacement has been shown valid, especially in high risk patients, but we still have little information and no “head to head” studies to know what is best in this...
Courtesy of Dr. Carlos Fava. Unprotected left main PCI (PCI-UPLMS) is an acceptable and comparable strategy vs CABG, although the use of IVUS is advisable, since it has shown better evolution and mortality. However, the adequate stent expansion remains unclear. Researchers carried out a sub-analyzis of the NOBLE trial. Of the total 603 patients receiving...