Compared against coronary artery disease (CAD) or cerebrovascular disease patients, peripheral artery disease (PAD) patients have lower chances of receiving medication proved to be clinically effective such as statins (despite running the same risk, perhaps even higher risk). The message is we should be more active both in finding risk factors in PAD patients, and...
Conventional non-invasive testing to detect obstructive coronary artery disease (CAD) by induced myocardial ischemia are not useful to diagnose epicardial or microvascular coronary artery spasm. Invasive testing requires the intracoronary injection of acetylcholine or ergonovine (the latter can also be endovenous). These tests are more often done in Asian countries, and rarely done in...
Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces...
Multiple drugs and treatment strategies have emerged in recent years to change significantly the prognosis of patients who suffer from stable chronic angina or, in terms of the latest guidelines, “chronic coronary syndromes.” This semantic change may seem of little importance, but it is intended to remind us that these are not stable patients, but...
After the “EXCEL scandal” at the end of last year, study investigators have been publishing explanations and sub-studies that were planned from the beginning, but which can still be interpreted as explanations. This sub-study states that revascularization was more common in the angioplasty arm, but only revascularizations performed on the target lesion, regardless of the...
A supplement (or anything, really) that might reduce simultaneously the risk of cardiovascular disease and of cancer would be truly revolutionary. This work, published in the New England Journal of Medicine (NEJM), sought to prove that vitamin D supplements might reduce the risk for both pathologies (the two most frequent diseases in the world). However,...
Courtesy of Dr. Carlos Fava. Advanced peripheral vascular disease is frequently associated with cardiovascular events and amputation. It has been proven that mono-antiplatelet therapy (MAPT) offers some benefit (with either aspirin or clopidogrel), but there are scarce data on the role of dual antiplatelet therapy (DAPT) in these patients. Researchers analyzed 404 patients who received MAPT for...
Infarctions with non-obstructive coronary artery disease, also known as MINOCA (myocardial infarction with nonobstructive coronary arteries), often present plaque rupture and thrombi associated with the affected myocardial territory. In these patients, optical coherence tomography (OCT) is of great value to identify the “culprit”. Even though atherosclerosis has been identified as a potential MINOCA mechanism, the...
Courtesy of Dr. Carlos Fava. Unprotected left main coronary artery angioplasty with drug-eluting stents has emerged as an acceptable strategy for a select group of patients, with results comparable to those of myocardial revascularization surgery at 2 or 3 years. However, beyond such term, we had no valid information. Researchers analyzed the 5-year follow-up results for the...
Courtesy of Dr. Carlos Fava. Generally, coronary artery dissection (SCAD) is not very frequent in young women and presents better evolution with medical treatment. However, it is occasionally associated with ST segment elevation. In this scenario, PCI with stent implantation is quite challenging. The study looked at 4298 STEMI patients; 53 presented SCAD (1.23%). STEMI-SCAD...