The ISCHEMIA trial will keep shedding light. The latest data show important differences between men and women as regards disease severity and its correlation with symptoms. Women have more angina than men but have less extensive ischemia. These findings were presented virtually at the ACC 2020, cancelled by COVID19, and suggest that, in addition to...
Virtual ACC 2020 | Myocardial Ischemia Induced by Sudden Mental Stress
Myocardial ischemia induced by sudden mental stress is associated with bad prognosis, especially in patients with a history of acute myocardial infarction according to this new study. This study, called MIMS-2, was meant to be presented at ACC 2020 together with the World Congress of Cardiology in Chicago, which was shut down because of the...
New European Guidelines on the Management of Lower Limb Acute Ischemia
Clinical practice guidelines are usually tedious and, frankly, while a lot of people make an enormous effort to write them, they are ultimately read in full by just a few. These new European Guidelines on the Management of Lower Limb Acute Ischemia represent a special team effort, since they include physicians, cardiologists, surgeons, and interventionists,...
Pre-TAVR Revascularization: Angiographic or Physiological?
In patients undergoing transcatheter aortic valve replacement (TAVR), fractional flow reserve (FFR) guided revascularization is associated with favorable results compared against the traditional angiography guided revascularization. Given the complete lack of randomized studies, this observational study is the best we have to decide how to guide revascularization in patients with symptomatic severe aortic stenosis undergoing...
The Most Read Scientific Articles in September at Solaci.org
1- ESC 2019 | New European Guidelines on “Chronic Coronary Syndromes” In Paris, during the European Society of Cardiology (ESC) Congress 2019 Scientific Sessions, new guidelines for the diagnosis and treatment of chronic coronary syndromes were presented. This document, simultaneously published in Euro Heart J, updates the 2013 guidelines on stable ischemic heart disease and...
Is TAVR at Hospitals Without Backup Cardiovascular Surgery Feasible?
Patients undergoing transcatheter aortic valve replacement (TAVR) at hospitals without cardiovascular surgery available are at significantly higher risk. That in itself is a call for attention; however, a propensity-matched analysis shows that the short- and long-term mortality rates are similar among patients treated at hospitals with and without cardiovascular surgery backup. This debate emerged a...
Frailty: What Happens When We Are Too Late in Critical Lower Limb Ischemia
This condition, now “trending” among patients undergoing transcatheter aortic valve replacement (TAVR), has expanded to almost all patients we treat, always with the same outcome: the prognosis is bad, so bad that it might warrant making the difficult decision of not going forward. The association between frailty and bad prognosis is easy to see and...
Frailty and Critical Limb ischemia: Facing a New Challenge
Courtesy of Dr. Carlos Fava. Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility. When it happens in frail patients, it presents a challenge. This population is on the rise and there is...
Cost-Effectiveness of Frenestrated or Branched Endoprostheses vs. Open Surgery
Fenestrated of branched endoprostheses are appealing options for the repair of anatomically-complex aortic aneurysms. Their use is limited by their cost (which is high for everyone, everywhere) and also by the lack of a head-to-head study showing best results than open surgery. This work offers results at 2 years for these devices, including an economic assessment...
EuroPCR 2018 | ORBITA: The Link Between Ischemia and Symptoms Is Still Not Entirely Understood
Invasive physiology tests used in the ORBITA trial could not predict which patients would benefit from angioplasty more than placebo (sham procedure) in terms of the trial’s primary endpoint, improvement in exercise time. These data were presented at EuroPCR 2018 and published simultaneously in Circulation. Results encourage debate over the importance of ischemia reduction with angioplasty...