The transradial approach has been associated to lower mortality and bleeding rates in patients receiving primary PCI for ST elevation MI. This had been called into question by the recent SAFARI-STEMI, but after including its outcomes in a new meta-analysis, the scales tilted slightly in favor of the transradial approach vs. the transfemoral. The transradial...
01- Ticagrelor or Prasugrel in ST Elevation MI In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately. Read more HERE 02- Number of Hours of Sleep and...
Intravascular imaging with coronary optical coherence tomography (OCT) and magnetic resonance imaging allow for the identification of the cause of heart attack in 85% of women without coronary obstructions in angiography. Myocardial infarction with non-obstructive coronary arteries (MINOCA) affects women disproportionately and we have considered these events as “false positives” for far too long. The...
Elderly patients (>70) with high cholesterol levels have been systematically excluded from randomized studies on statins, despite their higher risk of cardiovascular events. Presented at AHA 2020 Scientific Sessions and published simultaneously in the Lancet, along comes this primary prevention study including patients between 70 and 100 years of age. The use of therapies to...
01- How To De-Escalate Prasugrel After Acute Coronary Syndrome? Patients who undergo coronary angioplasty after acute coronary syndrome could de-escalate dual antiplatelet therapy with prasugrel to maintain the protection against ischemic events while lowering their hemorrhagic risk. Read more HERE 02- Not All Coronary Spasms Are the Same: Benefits of Acetylcholine Patients with documented spasm...
Should elderly patients stick to clopidogrel? The first large study on prasugrel showed an unacceptable increase of bleeding in elderly patients, suggesting the use of 5 mg (although the sample size was small, which hindered the determination of dose efficacy). Later, ticagrelor showed better efficacy than clopidogrel without apparent safety concerns. However, specific evidence on elderly...
In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately. Few studies have compared the efficacy and safety of the two most potent oral P2Y12 receptor inhibitors in...
Sleep duration (either short or long) affect the risk of stroke according to this recent analysis. We had visited a study published in JACC on the link between acute MI and sleep duration. This study appears to show similar results as regards sleep duration and stroke. The work prospectively included 79,881 men and women between...
Pretreating non-ST elevation acute myocardial infarction (NSTEMI) patients with P2Y12 receptor inhibitors is not associated with improved clinical outcomes as it is to increased bleeding. NSTEMI patients are often treated with platelet antiaggregants in the daily clinical practice despite the lack of evidence for its benefits. This Swedish registry prospectively included 64857 patients undergoing NSTEMI...
Transcatheter aortic valve replacement (TAVR) results durable at 5 years to treat failed surgical bioprosthetic valves and at one year to treat valves percutaneously. Regardless the type of the failed valve, the solution is TAVR. The 5 year follow up of the PARTNER 2 valve-in-valve (ViV) showed that TAVR as treatment for failed surgical bioprosthetic...