Most drug-eluting stents are coated by a polymer that is used to contain the antiproliferative drug. Once the drug is released, the polymer remains in place and its presence has been associated with inflammation, restenosis, and neoatherosclerosis. The MiStent device features a polymer that becomes bioabsorbable once the drug has been released, which could, theoretically,...
The LEADERS FREE study showed that a biolimus A9-coated polymer-free stent was superior to a conventional stent in terms of safety and efficacy in patients who received dual antiplatelet therapy for only a month due to their high risk for bleeding. In this substudy, researchers analyzed 667 patients enrolled in the original LEADERS FREE trial who met certain requirements...
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...
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...
The new COMBO stent, comprised of thin struts plus a bioengineered layer of endothelial progenitor cells, is safe and effective at 1 year, according to this registry (the largest study on this device to date). This new stent could provide a better option for patients at high risk for bleeding who may not be able to...
At 5 years, there were no differences in all-cause death, stroke, acute myocardial infarction, or all of these combined between low-risk, elderly patients who underwent transcatheter aortic valve replacement (TAVR) or conventional surgery. Taking into account reports from previous years, these results are not at all surprising. NOTION enrolled an all-comers population that was 70 years old...
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...
The authors have given an entertaining account of the most relevant points and differences between the new STEMI guidelines and the prior ones, from 2014. The article features 10 points resembling the ten commandments, which makes it easy to read, compared to the tedious task of reading the complete guidelines. 1) The emergency systems should help...
Courtesy of Dr. Pablo Baglioni. This is a prospective observational study with a 1-year follow-up analyzing 2062 patients with acute coronary syndrome (ACS) who have been treated with coronary angioplasty using new-generation drug-eluting stents (DES). Patients were included between December 21, 2012 and August 25, 2015. On May, 2014, due to changes in international guidelines, clopidogrel...
Courtesy of Dr. Alejandro Lakowsky, MTSAC. The Journal of the American College of Cardiology (JACC) has recently published a study on the role of coronary anatomy and PCI technical difficulty in the cost benefit ratio of prolonged vs. short post procedural DAPT. This study was carried out by Robert Yeh, Laura Mauri and the DAPT trial...