Both prasugrel and ticagrelor showed superiority in terms of efficacy, reducing the number of major cardiovascular events at the expense of increased bleeding. This is an affordable cost, and the net clinical benefit supports these new antiplatelet therapies. The one-year follow-up of the PRAGUE-18 study focused on a comparison of efficacy and safety between prasugrel...
International Conference: Coronary Angioplasty in Chronic Occlusions
The Buenos Aires Cardiovascular Institute (Instituto Cardiovascular de Buenos Aires, ICBA) is pleased to invite you to the International Conference on Coronary Angioplasty in Chronic Occlusions that will be held on March 13th at the ICBA auditorium (Blanco Encalada 1525, 1st floor, Buenos Aires City). The highlight of the event is the participation of...
Angioplasty vs. Surgery in Long-Term Critical Ischemia
Critical ischemia is the most advanced form of peripheral arterial disease, and it is characterized by ischemic rest pain and ulcers or gangrene. Revascularization is obviously positioned as the first-line treatment, and guidelines recommend both possible strategies (surgery or angioplasty) largely based on the findings of the BASIL trial (British Angioplasty versus Surgery in Ischemic...
Does a Combination of Diabetes and Acute Coronary Syndrome Change the Revascularization Strategy?
The results of the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial have shown a lower rate of events in patients with diabetes and stable multivessel disease who were randomized to undergo myocardial revascularization surgery, compared to those who underwent angioplasty. Surgery even showed a mortality reduction that...
What Is the Long-Term Outcome of Lesions Deferred Using FFR/iFR?
The presence of inducible ischemia is an essential prerequisite to obtain clinical benefits from revascularization through angioplasty. In that sense, the measurement of fractional flow reserve (FFR) is the gold standard as regards invasive methods assessing the functional significance of epicardial artery stenosis. As opposed to FFR, the measurement of the instantaneous wave-free ratio (iFR)...
The Use of Intravascular Imaging to Guide PCI Reduces Cardiovascular Death Risk, Compared to Angiography
Intravascular imaging, which includes ultrasound intravascular (IVUS) and optical coherence tomography (OCT), shows live details that better characterize post stenting plaque, anatomy and outcomes. The already familiar limitations of the angiography has lead us to think that IVUS and OCT could improve clinical outcomes; however, we should still find the evidence to support this claim. To shed some...
Quality of Life Between Surgery and Angioplasty for the Treatment of Left Main Disease
In recent years, angioplasty with drug-eluting stents (DES) has emerged as an alternative to myocardial revascularization surgery in patients with left main coronary artery disease. Both European and American guidelines offer a Class IIa recommendation for left main coronary artery (LMCA) angioplasty in selected patients. The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for...
Coronary Angioplasty Is a Valid Alternative for Left Main Coronary Artery Disease
Courtesy of Dr. Carlos Fava. Severe left main coronary artery (LMCA) lesions have a bad prognosis in coronary disease. In that scenario, current guidelines recommend surgery as the treatment of choice. However, due to the current development of second-generation drug-eluting stents (DES) and greater operator expertise, left main coronary artery angioplasty appears as a valid alternative...
Aspirin During Noncardiac Surgery: Only in Patients with Prior Angioplasty
A new analysis from the POISE-2 study suggests that aspirin should not be withheld prior to noncardiac surgery in patients with a history of coronary angioplasty, even if their coronary procedure occurred several years earlier. Patients with a history of coronary angioplasty who need cardiac surgery are more likely to benefit from continued aspirin therapy,...
iFR in Nonculprit Lesions: Measurement Timing May Change History
During primary angioplasty, it is not uncommon to see several other lesions in coronary arteries. Current guidelines advise against the treatment of these lesions in the same primary angioplasty procedure, although there is evidence supporting such a course of action that may warrant changes in these recommendations. The functional assessment of these nonculprit lesions may...