01- Virtual ACC 2020 | Controversial Trial ISCHEMIA Finally in NEJM In November 2019, during the American Heart Association (AHA) 2019 Scientific Sessions, researchers presented this revolutionary trial that called the attention of all cardiologists. We had to wait until March to read the fine print; back then, a global pandemic such as the current one seemed...
Global fractional flow reserve (FFR) results from adding up FFR values of the three major coronary arteries. This figure represents the physiological atherosclerosis burden and can predict events at long term in patients without stenosis leading to ischemia. This recent study published in JAHA looked at major cardiovascular events (death, infarction and revascularization) at 5...
Direct anticoagulant agents were associated with lower long-term mortality in patients with atrial fibrillation discharged after successful transcatheter aortic valve replacement (TAVR) compared with classic vitamin K inhibitors. Optimal anticoagulation in patients with atrial fibrillation (AF) undergoing TAVR is unclear. We are actually just starting to know what the ideal antiplatelet therapy is for patients undergoing...
Results confirm the interim analysis, whereby the study was suspended for futility. Omega-3 fatty acids do not reduce cardiovascular events in patients with high triglycerides and low HDL. Previous studies, such as REDUCE-IT, had shown positive results, but given this new research (presented at the American Heart Association [AHA] 2020 Congress and simultaneously published in...
When operators decide to proceed with PCI despite a negative FFR (fairly frequent in the daily practice) outcomes at 5 years are far worse. This information comes from a large Canadian register presented at AHA 2020 Scientific Sessions, simultaneously published in JAMA. PCI to a non-ischemic lesion results in increased events risk at long term,...
Using only one compressed tablet or pill with a fixed combination of statins, angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics significantly lowered cardiovascular risk in a large population without previous events (primary prevention). However, it presented an intermediate risk of cardiovascular disease onset. The TIPS-3 (The International Polycap Study 3) study had a 2-by-2-by-2 factorial design,...
The best strategy to treat in stent restenosis continues to be a dilemma. A new drug eluting stent (DES) seems to be the simplest treatment, even though it adds metal layers that will make it harder and harder to retreat. Drug coated balloons might be a viable alternative seeing as it seems to enable retreatment,...
In 2020, the European Society of Cardiology guidelines for the management of patients with acute coronary syndromes without ST-segment elevation (Non-ST-Segment Elevation Myocardial Infarction, NSTEMI) were presented. This document went somewhat unnoticed in the context of the COVID-19 pandemic, so this seems a good time to review it and set out some practical “commandments” (something...
Invasive functional measurement of intermediate lesions has become the gold standard to define revascularization. Due to its favorable long-term prognostic value, fractional flow reserve (FFR) is the reference used to compare all others. Recently, new nonhyperemic indexes, measured in a specific diastolic period, have emerged. Among them, the one with the most accumulated evidence is...
The benefits of intravascular ultrasound (IVUS) guidance in all angioplasties with second-generation drug-eluting stents (DES) persist through 3 years of follow-up. These data derive from the extended follow-up of the ULTIMATE study, presented virtually at TCT 2020 and published simultaneously in JACC Intv. At 3 years, target-vessel failure remained lower in patients whose angioplasty was guided by...