Three randomized studies showed exercising significantly improves 6-minute walk outcomes in patients with peripheral artery disease (PAD). However, many participants randomized to exercise did not perceive changes, and sometimes even got worse. These findings suggest a significant discrepancy between objective and perceived change in walking ability among PAD patients. 400 patients with peripheral artery disease...
Treating patients with functional stress test induced ischemia and non-obstructive coronary artery disease (INOCA) is complex and often frustrating. The multifactorial nature of this disease in addition to the complex physiopathological relationship between angina and ischemia turn these patients into a real headache for cardiologists. The CIAO-ISCHEMIA was recently published in Circulation and was designed...
This paper suggests that patients with stable coronary artery disease who undergo elective coronary revascularization find a long-term benefit in terms of cardiac death compared with patients who receive medical treatment alone. These findings, presented at EuroPCR 2021 and simultaneously published in the European Heart Journal, challenge the results from the ISCHEMIA trial. Researchers state...
Computed tomographic (CT) angiography showed a high degree of agreement with conventional angiography to detect significant coronary artery disease and rule out left main disease. This imaging study was done on a group of patients before their randomization in the ISCHEMIA trial. Data are soon to be published in JACC Cardiovascular Imaging and add plenty...
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...
Global fractional flow reserve (FFR) results from adding up FFR values of the three major coronary arteries. This figure represents the physiological atherosclerosis burden and can predict events at long term in patients without stenosis leading to ischemia. This recent study published in JAHA looked at major cardiovascular events (death, infarction and revascularization) at 5...
This research, which included thousands of patients treated for chronic inferior limb ischemia with drug-coated balloons, did not show an association between said devices and the increased mortality observed in some randomized trials. The long-term evidence from plenty of real-world patients contradicts what has been shown in randomized trials, leaving an information gap. Endovascular revascularization...
This prospective study analyzed patients with critical lower limb ischemia (due to complex, multiple lesions in several places) who were treated uniformly with common femoral artery endarterectomy combined with angioplasty to improve inflow and/or outflow. This hybrid treatment, which must be carried out by a team, can be greatly beneficial for this high-risk patient group...
This pre-specified protocol originally included 777 patients with chronic kidney failure. These patients are a special population of higher risk where we might be able to see the advantage of a more aggressive initial strategy. Death or MI rate (combined primary end point) resulted 36.4% for the invasive strategy vs. 36.7% for the initially conservative...