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,...
Courtesy of Dr. Alejandro Lakowsky, MTSAC. The Journal of the American College of Cardiology (JACC) has recently published a study on the role of coronary anatomy and PCI technical difficulty in the cost benefit ratio of prolonged vs. short post procedural DAPT. This study was carried out by Robert Yeh, Laura Mauri and the DAPT trial...
In the subgroup of patients with ST-segment elevation myocardial infarction who fail thrombolysis, transradial access reduces both bleeding and mortality, according to the results of this new study recently published in JACC Cardiovascular Interventions. Overall, transradial access following failed thrombolysis was associated with a 70% reduction in vascular complications, a 28% reduction in combined in-hospital...
Previous studies in which revascularization was guided by angiography alone found that coronary angioplasty does not improve outcomes compared with optimal medical treatment in patients with chronic stable angina. The FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared angioplasty guided by fractional flow reserve (FFR) with optimal medical treatment, arriving to...
Even in the hands of experienced operators, rechanneling and angioplasty of a chronic total occlusion (CTO) results in patients and the whole cath lab team receiving high doses of radiation, according to this registry presented at the American Heart Association 2017 Scientific Sessions. Up to 23% of patients who undergo rechanneling of a CTO receive...
Cardiac Artery Bypass Graft Surgery has been shown more effective than percutaneous coronary intervention (basically because it renders lower revascularization rate) in patients with severe left main bifurcation lesions receiving 1st generation drug eluting stents. This is why the 2014 American guidelines recommend CABG for most patients. But the EXCEL and the NOBLE trials brought back hope to...
The DAPT study concluded that continued thienopyridine plus aspirin beyond a year after coronary angioplasty is associated with a decrease in the rate of stent thrombosis and major cardiovascular events. In contrast, there is a significant increase in moderate to severe bleeding when compared with continued aspirin alone. Based on the outcomes of this and...
Courtesy of SBHCI. Angioplasty in patients with chronic stable angina and functionally significant lesions improves clinical outcomes and quality of life over the long term, as compared with optimal medical therapy alone. Furthermore, the invasive approach becomes more cost-effective as the years go by. Previously, FAME 2 had shown that angioplasty was initially more expensive, but...
Courtesy of the SBHCI. Chronic stable angina and severe coronary lesion patients who undergo angioplasty in a single vessel show no better outcomes than individuals who undergo a placebo sham procedure when it comes to exercise capacity and symptoms, according to this study presented at TCT and published simultaneously in the Lancet. The curious results...
Fentanyl is a potent opiate commonly administered in the cath lab. Recently, questions on its safety have been raised by research demonstrating that intravenous morphine significantly delays the absorption of oral P2Y12 platelet inhibitors. The mechanism might be slowed gastric emptying. The Platelet Aggregation with tiCagrelor Inhibition and FentanYl (PACIFY) trial enrolled 212 patients undergoing indicated...