Original title: Strategies for Multivessel Revascularization in Patients with Diabetes. The FREEDOM Trial. Reference: Michael E. Farkouh et al. N Engl J Med 2012. DOI: 10.1056/NEJMoa1211585 This study was designed to determine the best revascularization strategy in diabetic patients with multivessel using current techniques of angioplasty (PCI) and surgery (CABG). Randomized 1:1 diabetic patients with injuries > 70%...
Reference: Charlot et al. European Heart Journal 2012 (in press). International guideline recommendations approve giving dual antiplatelet therapy for a period of not less than 12 months after acute myocardial infarction. However, the benefit is unknown if the therapy is extended beyond 12 months. Perhaps its extension could be particularly useful in patients receiving pharmacological...
James SK, Storey RF, Khurmi N, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack. Circulation 2012. A sub-analysis of the PLATO study demonstrated similar superiority and the safety of ticagrelor in all patients, regardless of any previous history of stroke. Ticagrelor versus clopidogrel:...
Coronary artery disease is common among patients considered for transcatheter aortic valve implantation (TAVI). With the expansion of the indication for TAVI to a population with lower surgical risk, and therefore younger, there has been a gradual increase in the incidence of coronary events. However, there is limited data on treatment strategy and outcomes in...
In patients with peripheral vascular disease (PVD), the presence of diabetes has been significantly associated with increased failure of critical lower limb ischemia (CLI) treatment, and higher incidence of amputation. This relationship has been attributed mainly to comorbidities and patient characteristics, concomitant peripheral neuropathy and marked microvascular alteration. Also, a high proportion of these patients...
Long 48mm Stent XIENCE Skypoint in the treatment of diffuse CAD Long coronary artery lesions often involve complex decision making since they can be treated either with a long stent or with shorter overlapping stents. Both in registries and meta-analysis, the overlapping technique has been associated to increased target vessel revascularization and increased radioscopy time,...
Recent studies on antiplatelet antiaggregation support the use of short dual antiaggregation therapy (DAPT), even in unforeseen scenarios, such as complex PCI. On the contrary, in patients with high ischemic risk, there is still evidence in favor of prolonged antiaggregation, mainly through the DAPT study, which showed lower risk of major ischemic events with DAPT...
The proportion of patients treated with coronary angioplasty who are at a high risk for bleeding is increasing. In this population, extended dual antithrombotic therapy increases the risk of bleeding. The 1-year randomized Onyx one study has demonstrated the non-inferiority of zotarolimus-eluting stents (ZES) vs. biolimus-coated polymer-free stent BioFreedom (DCS). Patients received dual-antiplatelet therapy (DAPT)...
Cardiovascular disease is one of the main causes of morbidity and mortality in patients with advanced chronic kidney disease (CKD), and vice-versa. Both diseases share risk factors, including, but not limited to, diabetes, high blood pressure, smoking, dyslipidemia, and old age. As kidney disease develops, its severity grade has been linked to more thrombotic events...
In patients at high risk of bleeding undergoing coronary PCI and after completing 3-month DAPT with no events, you may discontinue aspirin and follow up with ticagrelor monotherapy. This will significantly reduce bleeding without increasing ischemic events. With this strategy, the greater the risk of bleeding, the greater the absolute reduction of bleeding. Patients at...