Courtesy of Dr. Carlos Fava. Chronic total occlusions (CTO) are still one of the greatest challenges in our field, thus forcing the development of different complex strategies to resolve them. Additionally, the use of imaging techniques during these procedures has improved long-term results. The CONSISTENT CTO (Conventional Antegrade Versus Sub-Intimal Synergy Stenting in Chronic Total Occlusions)...
There is no survival advantage with invasive coronary revascularization over initial medical treatment in patients with chronic coronary artery disease. However, revascularization did reduce the incidence of unstable angina and its symptoms, according to this new meta-analysis published in Circulation and presented virtually at EuroPCR 2020. There was no significant difference in spontaneous infarctions overall, but...
Conventional non-invasive testing to detect obstructive coronary artery disease (CAD) by induced myocardial ischemia are not useful to diagnose epicardial or microvascular coronary artery spasm. Invasive testing requires the intracoronary injection of acetylcholine or ergonovine (the latter can also be endovenous). These tests are more often done in Asian countries, and rarely done in...
Deferral of left main coronary artery lesions using instantaneous wave-free ratio (iFR) seems to be safe. At the least, patients with deferred lesions had similar long-term prognosis to that of patients who underwent revascularization based on that same indicator. Left main coronary artery lesions were universally excluded from studies including medical treatment among the therapeutic...
Patients undergoing non-ST elevation MI (NSTEMI) who are not pre-treated with P2Y12 receptor inhibitors will benefit from a very early intervention strategy. The optimal intervention timing for NSTEMI patients is still under debate, despite multiple studies, but the ideal timing had never been tested in patients with no platelet aggregation inhibitor pretreatment. After the surge of...
Courtesy of Dr. Carlos Fava. Aortic valve calcification and its resulting stenosis leads to changes in left ventricle hemodynamics, producing diffuse ischemia followed by inflammation, increased extracellular matrix, necrosis, and later, diffuse fibrosis. At present, with magnetic resonance imaging (MRI) we can analyze ventricular architecture and its function by detecting fibrosis (LGE) and its volume...
Administrating Recombinant Human C1-Esterase-Inhibitor (rhC1INH) before coronary angiography might mitigate contrast induced kidney injury. In addition, it shows a favorable safety profile in populations with multiple comorbidities. The contrast material used in all our diagnostic tests and therapeutic procedures causes tubular cytotoxicity and ischemia/reperfusion injury. rhC1INH had been effective at mitigating this mechanism in experimental...
01- Coronavirus and the Heart: How Should Cardiologists Prepare? As the number of confirmed cases increases throughout the globe, a picture is emerging as to what the direct cardiovascular effects of this pandemic may be. Read more HERE 02- TAVR: Should Transradial Approach be the Second Access Site? Courtesy of Dr. Carlos Fava. One of...
In patients with uncontrolled hypertension who do not comply with treatment, renal denervation can generate benefit by reducing both ambulatory and office blood pressure, compared with patients who underwent a sham procedure. This new information emerges from the SPYRAL HTN-OFF MED trial, presented virtually at the American College of Cardiology (ACC) 2020 Scientific Session and...
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few...