Cardiovascular disease is one of the main causes of morbidity and mortality in patients with advanced chronic kidney disease (CKD), and vice-versa. Both diseases share risk factors, including, but not limited to, diabetes, high blood pressure, smoking, dyslipidemia, and old age. As kidney disease develops, its severity grade has been linked to more thrombotic events...
Percutaneous coronary intervention in patients with acute myocardial infarction (AMI) where the physiopathological mechanism is plaque erosion or non-atherosclerotic mechanisms (such as spontaneous coronary artery dissection) is not beneficial according to recent studies. The EROSION study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion) has shown medical treatment with no...
Fractional flow reserve (FFR) proved to be very useful and safe in the FAME study, but its trade-off was using adenosine (which has a short half-life) and adverse reactions, which fortunately were rare. Subsequently, two large studies—the iFR-SWEDEHEART and DEFINE-FLAIR—demonstrated that instantaneous wave-free ratio (iFR) offered comparable results to FFR in the short term, avoiding...
FLAVOUR was a prospective randomized non-inferiority study in patients with intermediate coronary lesions (40%-70%) that compared two imaging modalities: IVUS (intravascular imaging) and FFR (fractional flow reserve). According to this research—presented at ACC 2022—, FFR-guided angioplasty was non-inferior to IVUS-guided angioplasty at 2 years of follow-up. Furthermore, using FFR-based imaging led to fewer stent implantations....
Percutaneous coronary intervention improves angina related quality of life in AMI patients with multivessel disease. The COMPLETE study has shown patients receiving complete revascularization compared against culprit-only revascularization presented lower cardiovascular rate or AMI at 3-year followup. ACC featured a COMPLETE subanalysis assessing angina related quality of life. It included 4041 patients, mean age 62,...
Percutaneous intervention of femoropopliteal lesions have been the standard strategy these past two decades. The development of drug eluting stents (DES) or drug eluting balloons (DEB) has improved patency rate compared against conventional balloon angioplasty. The ILLUMINA -a multicenter study- looked into the polymer free self-expanding stent NiTiDES, which showed at 1 year an 87%...
Roughly 40% of patients receiving a coronary angiography for stable angina (angina episodes twice a week despite medical treatment, lasting 3 months) do not present obstructive coronary artery disease (ANOCA). Between 60 to 90% is due to coronary vasomotor dysfunction (CVDys) which might be interpreted as vessel spasm or microvascular dysfunction. A recent publication from...
Prior research has shown that women with coronary artery disease who undergo percutaneous revascularization present more comorbidities, require less aggressive treatments, have greater long-term morbidity rates and worst functional status and/or post-procedure angina. This study used data from the CPORT-E trial (Cardiovascular Patient Outcomes Research Team Non primary Percutaneous Coronary Intervention) to assess baseline differences...
The recommended treatment for ST elevation acute myocardial infarction (STEMI) is early PCI, typically stenting. However, stent implantation always involves the risk of intravascular complications, such as stent thrombosis or restenosis. Sometimes stable flow is restored to the target vessel after initial PCI and we can omit stenting when there is no angiographically significant residual...
While the ideal treatment for coronary bifurcation is provisional stenting, this can be associated with side branch occlusion, which leads to severe adverse events. To prevent this complication, several treatments have been proposed. One of them is wire jailing at side branch before stent implantation in the main vessel. However, the actual benefit of this...