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,...
The benefits of transcatheter aortic valve replacement (TAVR) for high-risk, prohibitive-risk (class I) or intermediate-risk (class IIa) patients have already been proven, but there is a growing population of patients with a history of myocardial revascularization surgery (MRS) who experience severe aortic stenosis. Decision-making in these cases is anything but simple, mainly due to the presence of...
The association between aortic stenosis and some degree of mitral stenosis (MS) is around 10% (depending on the series), and it is related with negative outcomes. In high-risk and inoperable patients who underwent TAVR, that association and its significance have not been studied yet. The study analyzed data from the Society of Thoracic Surgeons/American...
Classical symptomatic low-flow, low-gradient (LFLG) severe aortic stenosis is associated with low survival rates at 3 years (<50%). However, in the medium term and with surgery, those rates improve (although mortality rates are 6%-30%, depending on the series). In patients without contractile reserve, surgical mortality is higher. Patient evolution in TAVR is still mostly unclear. ...
Delayed coronary obstruction (after TAVR, outside the cath lab) is a rare complication with high mortality rates, not unlike acute obstruction. Cardiologists should be expectant and, upon the slightest suspicion of this complication, patients should be brought back to the cath lab for a coronary angiography. Occlusion immediately after implant release has been well-studied and...
One in five patients presenting perioperative MI during non-cardiac surgery should be readmitted within 30 days after surgery, and one in seven dies within the same period, according to the new study presented at ACC 2018 scientific sessions and simultaneously published in Circulation. These infarctions could be considered a iatrogenic complication, given the obvious lack of proper...
This study compared 6 vs 12 or more months of dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) receiving contemporary DES, and it did not find differences in combined endpoint. However, looking at primary endpoint components separately, there were more infarctions in patients with a short DAPT scheme that we cannot ignore. Prolonging antiaggregation...
Ticagrelor seems as safe as clopidogrel in patients undergoing ST elevation MI treated with fibrinolytics, at least in terms of TIMI major bleeding at 30 days. Longer follow up will help determine whether there are differences in efficacy or safety issues, as stated by the presenter Otavio Berwanger. This study was presented at ACC 2018 scientific sessions...
At 5 years, there were no differences in all-cause death, stroke, acute myocardial infarction, or all of these combined between low-risk, elderly patients who underwent transcatheter aortic valve replacement (TAVR) or conventional surgery. Taking into account reports from previous years, these results are not at all surprising. NOTION enrolled an all-comers population that was 70 years old...
One in three “nondiabetic” patients who undergo angioplasty with current drug-eluting stents have an altered glucose metabolism, which is associated with a 4-fold higher risk of events, according to a study that will be published soon in JACC Intv. One in three patients is definitely one patient too many, and four times higher is definitely...