As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of<a href="https://solaci.org/en/2018/08/28/esc-2018-future-a-thorn-in-ffr-and-more-questions-than-answers/" title="Read more" >...</a>
The LEADERS FREE trial demonstrated that a polymer-free Biolimus A9-coated stent (BioFreedom™DCS; Biosensors Europe, Morges, Switzerland) is superior to a conventional stent (bare metal stent, BMS) in patients with high bleeding risk treated with only one month of dual antiplatelet therapy. Now, is this global study outcome applicable in cases of complex lesions with several<a href="https://solaci.org/en/2018/08/21/the-dangerous-combination-of-complex-angioplasty-and-high-bleeding-risk-seems-to-have-a-solution/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. The presence of CTO hovers around 15, 20% in coronary angiographies of patients with chronic stable angina, but only 5% receive percutaneous coronary intervention (PCI). One of the obstacles to percutaneous revascularization is the lack of relevant studies justifying it, though we do have different comparative studies that improve symptoms, ventricular<a href="https://solaci.org/en/2018/06/08/cto-revascularization-improves-quality-of-life/" title="Read more" >...</a>
Recent studies in patients undergoing acute myocardial infarction showed that a complete revascularization strategy in an acute or subacute setting, whether it be guided through angiography (PRAMI, CvLPRIT) or fractional flow reserve (FFR) (PRIMULTI, COMPARE-ACUTE), improves the combined endpoint of major adverse cardiac events (MACE) when compared with treatment of the culprit artery only. Based<a href="https://solaci.org/en/2018/05/29/europcr-2018-compare-acute-ffr-or-primary-angioplasty-at-a-2-year-follow-up-after-complete-revascularization/" title="Read more" >...</a>
After several trials with neutral outcomes, renal denervation had been demoted for some time. However, this new study presented at EuroPCR 2018 and simultaneously published in the LANCET brings back the technique with improved devices that seem to yield improved outcomes. The study included patients with uncontrolled arterial hypertension under medical treatment. Eligible patients<a href="https://solaci.org/en/2018/05/29/europcr-2018-spyral-htn-on-med-renal-denervation-comes-back-to-life/" title="Read more" >...</a>
The risk of stroke is inherent to TAVR and, apart from clinically manifest events, there is abundant evidence of cerebral embolic lesions during TAVR provided by studies using diffusion weighted MRI or transcranial doppler ultrasound. Several devices have been developed to reduce the risk of stroke, though they have been assessed by relatively small trials<a href="https://solaci.org/en/2018/05/29/europcr-2018-meta-analyzis-on-cerebral-protection-devices-during-tavr/" title="Read more" >...</a>
Several studies are defining the role of transcatheter aortic valve replacement (TAVR) in patients with low surgical risk. One of the main concerns for this population, whose life expectancy is much longer, has to do with TAVR durability compared with a surgically-implanted biological valves. The Nordic Aortic Valve Intervention (NOTION) trial was the first study<a href="https://solaci.org/en/2018/05/29/europcr-2018-notion-good-tavr-durability-compared-with-surgically-implanted-valve-in-low-risk-patients/" title="Read more" >...</a>
Invasive physiology tests used in the ORBITA trial could not predict which patients would benefit from angioplasty more than placebo (sham procedure) in terms of the trial’s primary endpoint, improvement in exercise time. These data were presented at EuroPCR 2018 and published simultaneously in Circulation. Results encourage debate over the importance of ischemia reduction with angioplasty<a href="https://solaci.org/en/2018/05/24/europcr-2018-orbita-the-link-between-ischemia-and-symptoms-is-still-not-entirely-understood/" title="Read more" >...</a>
Hybrid revascularization seems to achieve results similar to those of conventional myocardial revascularization surgery at 5 years, although studies published so far do not seem to be enough for a definitive answer. This new work, soon to be published in J Am Coll Cardiol Intv, has had promising results in selected patients with multivessel disease; however,<a href="https://solaci.org/en/2018/05/07/hybrid-revascularization-or-conventional-surgery-history-is-still-being-written/" title="Read more" >...</a>
Long-term follow-up of patients under 50 with multivessel coronary artery disease suggests surgery outcomes are significantly better than angioplasty outcomes. This study, presented at the Society of Thoracic Surgeons’ (STS) Annual Meeting, concludes that surgery should continue as plan A when it comes to young patients with three-vessel disease. Surgeons complain that many patients never actually<a href="https://solaci.org/en/2018/03/22/surgery-seems-superior-to-angioplasty-in-young-patients/" title="Read more" >...</a>