According to previous studies, patients receiving bilateral internal mammary artery conduits during coronary artery bypass grafting have better survival than those receiving a single internal mammary artery. The reason behind this remains unclear, let alone whether there really is lower repeat revascularization rate. This analysis compared timing, frequency, and type of repeat coronary revascularization among patients...
HREVS: Hybrid Revascularization Offers No Advantage in Multivessel Disease
Courtesy of SBHCI. Hybrid revascularization, which combines CABG with PCI, failed to reduce myocardial ischemia and major cardiac and cerebrovascular events, compared to cardiac artery bypass graft or PCI separately. However, this small study does not provide conclusive evidence, which calls for further randomized studies with enough statistical power to answer this question. Fortunately, we won’t have...
SYNTAX II: Better Stents, IVUS, FFR, or a Combination of All of Them to Catch Up with Surgery
In patients with 3-vessel disease, surgery obtained better outcomes than angioplasty, according to results from the SYNTAX and FREEDOM trials, which used first-generation drug-eluting stents. Even in the BEST trial, which used new-generation stents, surgery still offered far better outcomes. Nobody is surprised by the fact that, whenever angioplasty evolves due to a new device...
Closing off the Appendage While Performing Cardiac Surgery Results in a Reduction in Risk of Embolic Stroke
Closing off the left appendage as an add-on procedure while performing other cardiac surgery in patients with atrial fibrillation resulted in a reduction in risk of embolic stroke of nearly 40% over 12 months, according to an analysis carried out on the Society of Thoracic Surgeons (STS) database. Patients who had surgical appendage occlusion had...
Best Revascularization Strategy for Severe Carotid and Coronary Artery Disease
Courtesy of Dr. Carlos Fava. Carotid artery disease is an important cause of stroke and is associated to coronary artery disease. When patients need myocardial revascularization surgery (Carotid Artery Bypass Graft) and cannot wait one month or more for carotid revascularization, the optimal management strategy is still controversial. The aim of this study was...
Incomplete Revascularization: Increased Events Rate in Non-Cardiac Surgery?
The aim of this study was to determine whether incomplete revascularization is associated to higher adverse events risk and acute myocardial infarction in patients undergoing non-cardiac surgery. Coronary artery disease patients or patients with prior PCI often have non cardiac surgery. These patients may have had all obstructions treated before surgery (complete revascularization) or...
Left Main Coronary Artery Angioplasty vs. Surgery: A Large Meta-Analysis
Courtesy of Dr. Carlos Fava. Around 5% of patients undergoing coronary angiography present severe left main coronary artery (LMCA) lesions. Myocardial revascularization surgery (MRS) is the preferred method for this group, although there is evidence from different randomized trials demonstrating the safety and efficacy of unprotected LMCA angioplasty, with results similar to those obtained through the traditional strategy....
Carotid Revascularization After Stroke: When Should It Be Performed?
In 2006, the American Heart Association guidelines recommended that carotid revascularization be performed within 2 weeks of stroke based on data from 2 randomized trials on carotid endarterectomy. This study aimed to determine whether the time between the event and revascularization has decreased after these guidelines were issued, and the proportion of patients receiving some sort of revascularization (endarterectomy...
Left Main Coronary Artery Angioplasty Would Be Non-Inferior to Surgery
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...
LEMANS Trial: Left main stenting vs. surgery at 10 years
Original Title: Left main stenting in Comparison with Surgical Revascularization 10-year outcomes of the (Left Main Coronary Stenting) LE MANS trial. Reference: Buszman P et al. J Am CollCardiolIntv. 2016;9(4):318-327. doi:10.1016/j.jcin.2015.10.044. Courtesy of Dr. Guillermo Migliaro. Long term outcomes of left main stenting are unknown. This study reports 10 year follow up outcomes of the LEMANS trial patients. The...