Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously...
The EXCEL trial did not find the sex of patients with left main coronary artery disease to be an independent predictor of adverse events after revascularization. However, women who underwent angioplasty had a trend towards worse outcomes, a finding that might be related to comorbidities and somewhat increased chances of peri-procedural complications. In its formal...
Courtesy of Dr. Carlos Fava. Mitral regurgitation accounts for around 25% of valvular diseases and is a strong mortality predictor in heart disease. One of the challenges of this disease is that patients respond favorably to medical treatment for a long time, which makes hard to establish the right time to perform an intervention without...
Courtesy of Dr. Carlos Fava. The incidence of kidney disease is increasing. In its final stage, this pathology is related with coronary disease and increased mortality. Furthermore, we know that, in many occasions, it is associated with diabetes. Nowadays, the evidence comparing the progress of patients with impaired kidney function who have undergone left main...
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of...
Hybrid revascularization seems to achieve results similar to those of conventional myocardial revascularization surgery at 5 years, although studies published so far do not seem to be enough for a definitive answer. This new work, soon to be published in J Am Coll Cardiol Intv, has had promising results in selected patients with multivessel disease; however,...
Long-term follow-up of patients under 50 with multivessel coronary artery disease suggests surgery outcomes are significantly better than angioplasty outcomes. This study, presented at the Society of Thoracic Surgeons’ (STS) Annual Meeting, concludes that surgery should continue as plan A when it comes to young patients with three-vessel disease. Surgeons complain that many patients never actually...
Whether a second arterial conduit improves outcomes in patients undergoing myocardial revascularization surgery is and will remain unclear until the 10-year results of the ART (Arterial Revascularization Trial) are published. Consequently, arterial conduits other than the left internal thoracic artery are seldom used in daily practice. Using a database including 126 non-federal hospitals in California, researchers...
The results of the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial have shown a lower rate of events in patients with diabetes and stable multivessel disease who were randomized to undergo myocardial revascularization surgery, compared to those who underwent angioplasty. Surgery even showed a mortality reduction that...
In recent years, angioplasty with drug-eluting stents (DES) has emerged as an alternative to myocardial revascularization surgery in patients with left main coronary artery disease. Both European and American guidelines offer a Class IIa recommendation for left main coronary artery (LMCA) angioplasty in selected patients. The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for...