Courtesy of Dr. Carlos Fava. The presence of CTO hovers around 15, 20% in coronary angiographies of patients with chronic stable angina, but only 5% receive percutaneous coronary intervention (PCI). One of the obstacles to percutaneous revascularization is the lack of relevant studies justifying it, though we do have different comparative studies that improve symptoms, ventricular...
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...
Patients undergoing acute coronary syndrome (ACS) loaded with a high dose of statins prior diagnostic catheterization do not seem to benefit from this strategy. However, when looking at those undergoing PCI alone (excluding all patients who had received surgery or medical treatment), the benefit appears as a reduction of combined major events. The benefit of atorvastatin loading...
This study compared 6 vs 12 or more months of dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) receiving contemporary DES, and it did not find differences in combined endpoint. However, looking at primary endpoint components separately, there were more infarctions in patients with a short DAPT scheme that we cannot ignore. Prolonging antiaggregation...
Long-term follow-up of patients under 50 with multivessel coronary artery disease suggests surgery outcomes are significantly better than angioplasty outcomes. This study, presented at the Society of Thoracic Surgeons’ (STS) Annual Meeting, concludes that surgery should continue as plan A when it comes to young patients with three-vessel disease. Surgeons complain that many patients never actually...
Around half of all cases of ST-segment elevation acute myocardial infarction (STEMI) come alongside lesions in another vessel, for which the current strategy is complete revascularization in one or two steps. However, there are no large-scale studies analyzing patients who also present cardiogenic shock; we only have observational studies with inconclusive results influenced by several...
Several studies show that patients with multivessel lesions who undergo angioplasty with incomplete revascularization experience more events, including higher mortality, than a cohort of patients who have undergone complete revascularization. In most cases, the analysis was dichotomic (complete vs. incomplete revascularization), but more recent studies show that there may be a gradient, a continuum, in...
Dyspnea is one of the most challenging symptoms as regards its assessment and treatment in patients with coronary disease, since it may stem from both cardiac and non-cardiac causes. Patients in whom dyspnea is the sole symptom of coronary disease are at a higher risk of not receiving adequate treatment, and their short- and long-term...
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...
Courtesy of Dr. Ariel Durán. I am pleased to witness the increased amount of scientific papers in high impact journals addressing topics related to radiation protection or the harmful effects of radiation on our patients and primary or secondary operators. Similarly, it is my pleasure to see that SOLACI has acknowledged this growing concern by...