The Covid-19 pandemic has dramatically altered reperfusion therapy access in patients undergoing ST elevation MI. In these adverse times, it seems prudent to reassess the reperfusion algorithm. Even though primary PCI is the standard reperfusion strategy, to fully benefit from it is essential to keep first medical-contact-to-PCI time between 90 to 120 minutes (depending on...
ST elevation acute myocardial infarction has high mortality and morbidity rates. It is normally treated with primary PCI. The whole system has established very effective protocols to minimize ischemic time from symptom onset to definite treatment in the cath lab. This study reports the experience in Hong Kong since January 2020, when all emergency protocols...
01- ECS Guidelines for COVID-19 Management One of the first statements in this document points out these are not “regular guidelines” developed after thorough analysis of all the available evidence published since the last update. Instead, they are meant to provide temporary basic management pointers on how to handle different scenarios of cardiac patients in the...
In recent times, a lot has been said about reducing the duration or intensity of antiplatelet therapy following percutaneous coronary intervention (PCI) regardless initial indications. All evidence in support of these arguments might be failing to show the risk of non-culprit lesion events in patients with acute coronary syndromes (ACS). Potent and prolonged antithrombotic therapies...
Administrating Recombinant Human C1-Esterase-Inhibitor (rhC1INH) before coronary angiography might mitigate contrast induced kidney injury. In addition, it shows a favorable safety profile in populations with multiple comorbidities. The contrast material used in all our diagnostic tests and therapeutic procedures causes tubular cytotoxicity and ischemia/reperfusion injury. rhC1INH had been effective at mitigating this mechanism in experimental...
We are living a pandemic due to the new COVID-19, but the world was already in the midst of a pandemic of cardiovascular disease. Both challenges defy healthcare systems worldwide, and the worst part is that they can coexist. Some symptoms for both diseases can overlap (such as respiratory distress) and they are unreliable, like...
Magnetic resonance (MR) and fractional flow reserve (FFR) correlate moderately as regards the assessment of non-culprit lesions in patients admitted with acute myocardial infarction who underwent primary angioplasty. For a similar degree of diagnostic accuracy, we would require a visual, semiquantitative, or fully quantitative comprehensive assessment of lesions. This work, soon to be published in...
01- Coronavirus and the Heart: How Should Cardiologists Prepare? As the number of confirmed cases increases throughout the globe, a picture is emerging as to what the direct cardiovascular effects of this pandemic may be. Read more HERE 02- TAVR: Should Transradial Approach be the Second Access Site? Courtesy of Dr. Carlos Fava. One of...
The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial showed the 30-day superiority of patient transport to a primary angioplasty site vs. fibrinolysis at the hospital where the patient had been originally admitted. Those 30-day results became a landmark in the history of interventional cardiology. However, some suspected that such initial benefit could fade away over...
A large proportion of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. These patients have poorer 5-year outcomes compared with those subjected to a pharmaco-invasive strategy. ST-segment elevation myocardial infarction guidelines recommend primary angioplasty as the strategy of choice within 120 min after a diagnostic electrocardiography. If that is not possible, thrombolytic...