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...
01- ESC 2020 | New European Guidelines on Non-ST-Segment Elevation Acute Coronary Syndromes: What’s New? The new European guidelines on NON-ST-segment elevation acute coronary syndromes (NSTE ACS) were presented virtually during the European Society of Cardiology 2020 Congress (ESC 2020) and published in Eur Heart J. Read more HERE 02- Ticagrelor to Improve Venous Graft Patency Saphenous...
Patients with documented spasm to the coronary arteries present increased risk of myocardial infarction (MI) and repeat angiography, while patients with microvascular spasm are associated to recurrent angina. Globally, the prognosis of all these patients continues to be favourable, even though acetylcholine testing might help distinguish one-another. Coronary spasm shows in up to 60% of...
Read the case presentation and join the conversation through the comments in this post! Case Introduction: An Explosive Mission! 56-year-old male patient Severe smoker Hypertension Dyslipidemia Sedentary lifestyle and stress A sibling suffered from an acute myocardial infraction Cardiac markers: Standard angina, intensity of 8-9/10, 3-to-4-h long, and dyspnea (on and off for the past...