This very interesting work leaves us with a sour taste in our mouth, as it failed to meet its primary endpoint. Using genotype to individualize treatment with a P2Y12 inhibitor in patients with acute coronary syndrome or stable patients after a scheduled angioplasty compared with conventional treatment with clopidogrel does not reduce the risk of...
16 Years of Superiority of Primary Angioplasty
The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial showed the 30-day superiority of patient transport to a primary angioplasty site vs. fibrinolysis at the hospital where the patient had been originally admitted. Those 30-day results became a landmark in the history of interventional cardiology. However, some suspected that such initial benefit could fade away over...
Alternatives for Patients Allergic to Aspirin
Intolerance to aspirin is relatively frequent and there is no other non-steroid anti-inflammatory medication to replace it. The new guidelines of chronic coronary syndromes make class IIb recommendations to use prasugrel or ticagrelor in aspirin-intolerant patients. This is not meant to replace dual antiaggregation therapy in aspirin intolerant patients, when needed; it is just a...
Routine Continuous Monitoring After Angioplasty Might Not Be Necessary
According to a recent study published in Circ. Cardiovasc Interv, after a scheduled angioplasty, the rate of arrhythmia requiring some kind of treatment is very low, low enough to deem unnecessary the routine monitoring of all patients. The standard policy at many institutions is continuous cardiac monitoring for several hours after undergoing coronary angioplasty, with...
Impella: A Revolutionary Device Being Questioned
Observational studies (with their subsequent limitations) show a possible increase in adverse events and costs with the use of the Impella device. Two large observational studies stirred doubts regarding the good performance of new circulatory support devices in real-world daily clinical practice. There were more adverse events, including in-hospital death and major bleeding, and more...
Secondary Prevention: A Responsibility We Should Not Delegate
After coronary angioplasty, the use of drugs whose efficacy for the reduction of major events has been proven declines over time, which is associated with worse patient prognosis. Sometimes, without meaning to, we convey to patients the idea that, once the stent has been implanted, the artery is “cured” or that the only potential future...
Off-hours Primary PCI Still Have the Highest Mortality Rate?
According to this contemporary study, in the current organized STEMI network, patients admitted to a tertiary high-volume center for primary PCI are managed similarly and have similar prognosis regardless admission time. Several prior studies have shown primary PCI during off-hours (6 pm to 8 am) had worse outcomes vs. on-hour interventions (8 am to 6...
Should Post-PCI Biomarkers Elevation Be of Concern?
Elevated markers after PCI in stable patients treated with the latest generation stents continues to happen. However, only the association between biomarker elevation with creatine kinase-myocardial band (CK-MB) should be of concern, sin it was associated with mortality at one year. Post procedural cardiac troponin (cTn) elevation was not associated to future events, according to...
Trying to Reduce Post TAVR Kidney Injury
Acute kidney injury is a common complication after transcatheter aortic valve replacement (TAVR) and is associated to increased mortality both short and long-term. In patients undergoing percutaneous coronary intervention (PCI) forcing diuresis with controlled hydration has shown to reduce the incidence of acute kidney injury in nearly 50%. However, this has not been tested in...
TCT 2019 | PCI in Stable CAD. Prior TAVR, with TAVR or Never?
Courtesy of SBHCI. This interesting study presented at TCT 2019 and simultaneously published in Am J Cardiol tells us PCI in stable coronary artery disease cannot lower risk in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Unless patients are symptomatic, most coronary artery lesions do not need revascularization according to researchers....