Courtesy of Dr. Javier Castro. Certain coronary lesions have been historically discouraged for endovascular treatment. Among these can be found left main coronary artery lesions, multivessel disease, and proximal anterior descending artery lesions. As a matter of fact, the latter is actually considered separately as a criterion for choosing the revascularization method. Endovascular treatment of...
The FUTURE study, testing the utility of functional revascularization by measuring the fractional flow reserve (FFR), was halted early by its safety committee due to an increased mortality rate at 1 year among patients guided by FFR. In this unexpected unprecedented outcome, 17 patients in the FFR-guided group died at a year of follow-up, compared with 7 patients...
Courtesy of Dr. Carlos Fava. Left main coronary artery disease (LMD), has historically been treated with myocardial revascularization surgery (CABG), but for some years now, and with the development of new drug eluting stents (DES), percutaneous coronary intervention (PCI) has been gathering support in this challenging territory. The study analyzed the SYNTAX and PRECOMBAT...
The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute Myocardial Infarction 2015 suggest that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PCI). This study compared the impact of pharmacoinvasive strategy with the impact of primary angioplasty in real-world patients admitted with acute coronary syndrome with ST-segment elevation. The...
A comprehensive analyzis of cerebrovascular events in major randomized controlled studies on transcatheter aortic valve replacement (TAVR) has shown some interesting data on both risks and timing of stroke in this setting. The study carried out by Dr. Neal Kleiman, reviewed data on stroke and stroke predictors among 3,687 patients included in the CoreValve...
Original Title: Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. Reference: Steven P. Sedlis et al. N Engl J Med 2015;373:1937-46. Courtesy of Dr. Santiago Alonso. Centro Cardiológico Americano. Sanatorio Americano. Montevideo, Uruguay. During a median follow up of 4.6 years, with 2287 stable heart disease or silent ischemia patients,...
This is the first trial that used autologous cardiac stem cells for the treatment of ischemic cardiomyopathy. It consecutively enrolled 37 patients with reduced ejection fraction (lower than 40%) before myocardial revascularization surgery. It was administered by intra coronary infusion and 17 were control subjects. In the group injected with stem cells, EF significantly improved...
Original title: Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina. Reference: Verheye S et al. N Engl J Med 2015 Feb 5;372(6):519-27. The number of patients with severe diffuse coronary artery disease who are not candidates for revascularization is growing in Western countries, generating multiple procedures and increasing healthcare expenditure. New and unconventional solutions...
Original title: Frecuency domain optical coherente tomography to assess non-ostial left main artery. Reference: Francesco Burzotta, et al. EuroIntervention 2015;10e1-e8 Optical coherence tomography (OCT) has proved valuable in making decisions and monitoring stents implanted in coronary arteries, but its role in the assessment of left main (LM) lesions remains unclear. The study included 54 patients presenting moderate...
Original title: Predicting Outcome in the COURAGE Trial. Coronary Anatomy Versus Ischemia. Reference: G. B. John Mancini et al. J Am Coll Cardiol Intv 2013, Article in press. Anatomical risk, ischemic amount or a combination of both, are often factors taken into account for estimating the prognosis or choose a treatment strategy. The COURAGE study (Clinical Outcomes Utilizing...