Dual antiaggregation therapy (DAPT) with ASA and P2Y12 during 6 to 12 months is the indicated strategy after DES stenting to reduce ischemic events. However, in patients with elevated risk of bleeding (HBR) guideline and expert recommendations is 1-6 months, since there is plenty of evidence in favor, except for a randomized study, the MASTER...
New revascularization after coronary artery bypass graft (CABG) is often needed, be it because of severe bridge lesion, intimal hyperplasia, thrombosis, atherosclerosis, or native vessel lesion progression. We therefore need to determine the best revascularization strategy, namely native or graft percutaneous intervention, venous or arterial, or repeat surgery, with the risk it entails. There is...
The WOEST study found a significant reduction in bleeding complications post PCI with oral anticoagulation indication (OAC) when treating patients with dual antiplatelet therapy (DAPT) vs. the triple antithrombotic scheme. Several randomized studies have shown these results. At present, the guidelines recommend using the triple antithrombotic scheme in patients according to ischemic and bleeding risk. ...
Percutaneous coronary intervention in patients with acute myocardial infarction (AMI) where the physiopathological mechanism is plaque erosion or non-atherosclerotic mechanisms (such as spontaneous coronary artery dissection) is not beneficial according to recent studies. The EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) has shown medical treatment with no...
Percutaneous coronary intervention improves angina related quality of life in AMI patients with multivessel disease. The COMPLETE study has shown patients receiving complete revascularization compared against culprit-only revascularization presented lower cardiovascular rate or AMI at 3-year followup. ACC featured a COMPLETE subanalysis assessing angina related quality of life. It included 4041 patients, mean age 62,...
The recommended treatment for ST elevation acute myocardial infarction (STEMI) is early PCI, typically stenting. However, stent implantation always involves the risk of intravascular complications, such as stent thrombosis or restenosis. Sometimes stable flow is restored to the target vessel after initial PCI and we can omit stenting when there is no angiographically significant residual...
The mortality of ST-segment elevation acute coronary syndromes (STEACS) has decreased thanks to improved reperfusion times (fibrinolysis or primary angioplasty), so that, in daily practice, there is a greater number of patients with stable acute myocardial infarction (AMI). This clinical stability and a low rate of complications raise the question of whether performing triage is...
The potent and fast endovenous platelet inhibition provided by Cangrelor reduces ischemic events early in the course of acute coronary syndrome. However, and despite mounting evidence, the drug is not reaching the clinical practice. This is a sub-analysis of the CHAMPION PHOENIX, which sought the timing, number and type of early events that could be...
This last year, new data in pharmacology gave way to changes in practices and new hypotheses, when not simply further justified the already existing evidence. In this new editorial section, we share the most relevant of last year’s works to keep you up to speed on the main topics in the field. The Most Relevant...
Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) will benefit from rivaroxaban monotherapy both in terms of safety and efficacy. The AFIRE study included 2215 patients with atrial fibrillation and stable coronary artery disease (CAD). A subgroups analysis recently published in JACC Intv evaluated patients undergoing coronary stenting. The study compared rivaroxaban + antiplatelet...