Nearly 8 years later, CABG maintains its benefit over PCI-DES in terms of mortality in diabetic patients with multivessel disease, according to the Freedom trial, presented by Dr. Fuster at AHA and simultaneously published in JACC. CABG is superior to PCI-DES, with 36% higher mortality in these last years. Considering the nature of atherosclerosis,...
Courtesy of Dr. Carlos Fava. We are well aware of transcatheter aortic valve replacement’s (TAVR) effect in high-risk or inoperable patients at 5 years, even more after the PARTNER 1 trial. Yet, the outcomes of another relevant randomized study remained pending: el CoreValve US Pivotal High-Risk Trial. The CoreValve US Pivotal High-Risk Trial looked at the...
At 10-year follow-up, unrecognized or silent MIs have similar mortality to clinically recognized MI and, even though this does not justify routine screening, these findings call for more aggressive prevention. Unrecognized MI, detected by MRI, is associated to long term mortality risk similar to that of recognized MI; therefore, these patients have higher risk...
Polymer-free amphilimus-eluting stents are a novel technology combining sirolimus and long-chained fatty acids. This enhances the uptake of antiproliferative agents and may be associated with lower restenosis, particularly among patients with diabetes. The new device includes abluminal reservoirs filled with the drug; in consequence, there is no need for polymer. This work compares this new...
This work, presented at TCT 2018 and published simultaneously in The Lancet, is the first randomized study comparing a zotarolimus-eluting stent with a new thin-strut structure and limited radiographic visibility (Onyx), and a bioresorbable polymer-coated sirolimus-eluting stent (Orsiro). Onyx was developed to improve visibility while reducing strut thickness. To that end, a dense platinum–iridium core and...
The decision to be made with a treatment-free patient with systolic blood pressure over 160 mmHg or diastolic blood pressure over 100 mmHg is an easy one. All guidelines agree: treatment should be started immediately alongside lifestyle changes. In the case of patients with systolic blood pressure between 140 and 159 mmHg or diastolic blood pressure between 90...
These new hypertension guidelines (which were as long-awaited as the American ones, back then) finally emerged in Barcelona, at the European Society of Hypertension (ESH) Congress. The document was issued jointly with the European Society of Cardiology (ESC). These guidelines provide recommendations for physicians to diagnose hypertension, evaluate risk, and determine when and how to...
Repeat revascularization rate has historically been the weak spot of PCI when compared against CABG: we are still unable to compete with a well done internal mammary artery graft connected to the anterior descending artery. However, repeat revascularization is the soft of end points commonly assessed in trials, and even though several studies have shown...
The obvious risk of bleeding posed by aspirin was too clear in this work, casting a shadow of doubt over the indication of aspirin for primary prevention in diabetic patients. According to the ASCEND trial, presented at the European Society of Cardiology (ESC) 2018 Congress and simultaneously published in NEJM, aspirin reduces cardiovascular events as...
The LEADERS FREE trial demonstrated that a polymer-free Biolimus A9-coated stent (BioFreedom™DCS; Biosensors Europe, Morges, Switzerland) is superior to a conventional stent (bare metal stent, BMS) in patients with high bleeding risk treated with only one month of dual antiplatelet therapy. Now, is this global study outcome applicable in cases of complex lesions with several...