Courtesy of Dr. Cristian Jesús Rodríguez. Most stents currently used in percutaneous coronary intervention (PCI) are durable-polymer second-generation drug-eluting stents (DP-DES, with everolimus or zotarolimus). However, it has been argued that the persistence of such a polymer after complete drug elution is one of the main factors for a dangerous complication: stent thrombosis (ST). After...
The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be...
The association between glycemic control after coronary angioplasty and outcomes of the latter is controversial in many studies. We have come to think that the risk lies in suffering from diabetes, as if it was an unmodifiable factor. We have also come to believe that glycemic control can impact microvascular complications while it cannot do...
Courtesy of Dr. Carlos Fava. Left main coronary artery (LMCA) lesions have always been defined as high-risk, with surgery as treatment of choice. Drug-eluting stents (DES) have slowly changed that, but their use still lacks strong supporting evidence. The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) study...
Courtesy of Dr. Agustín Vecchia. The link between operator volume and clinical outcomes has been long and widely debated. After years of discussion, there are promoters and detractors. Currently, interventional cardiology societies all over the world classify centers as “high-volume” or “low-volume” using arbitrary parameters, and require training fellows to perform an also arbitrary number of...
Original Title: iFR/FFR and IVUS-guided percutaneous coronary revascularization with new-generation DES in patients with de novo three-vessel disease: 30-day outcomes of the SYNTAX II trial. Presenter: P. W. Serruys. The European Society of Cardiology guidelines recommend PCI for patients with multivessel disease and a Syntax score. A prospective, multicenter, single arm study was carried...
This study is still in progress and includes patients using SYNTAX II score based on functional invasive evaluation with iFR / FFR and performing angioplasty guided by IVUS using the biodegradable polymer everolimus eluting stent. The study seeks to prove superiority versus the first generation paclitaxel-eluting stent and non-inferiority versus surgery using historical data. We...
Original title: Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Reference: Morice MC et al. Circulation. 2014 Jun 10;129(23):2388-94. Current guidelines recommend CABG as the strategy of choice for treating lesions of...
Título original: Riociguat for the Treatment of Pulmonary Arterial Hypertension. Referencia: Hossein-Ardeschir Ghofrani et al. N Engl J Med 2013;369:330-40. Many drugs have been tested for pulmonary arterial hypertension (PAH) including PDE5 inhibitors, prostanoids and endothelin receptor antagonists, however there are still missed targets in the treatment of this disease. Riociguat is a drug belonging to a...
Original title: The Negative Impact of Incomplete Angiographic Revascularization on Clinical Outcomes and Its Association With Total Occlusions. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) Trial. Reference: Vasim Farooq et al. J Am Coll Cardiol 2013;61:282–94 In patients with complex coronary artery disease who underwent coronary artery bypass surgery, (CABG), or percutaneous transluminal...