This is another study that concludes that beta-blockers have no impact on mortality at 1 year after infarction in stable patients and offer no survival benefit to patients with stable ischemic heart disease who have not experienced a myocardial infarction. This analysis represents 5 years of follow-up in a large, multinational registry and also shows a lack...
Increases in the rates of revascularization and heart failure do not justify the early mortality advantage shown by treatment of the culprit artery only in patients with acute myocardial infarction and cardiogenic shock. The 1-year follow-up of the CULPRIT-SHOCK trial reinforces the idea of only treating the culprit artery, with an option for revascularization of...
As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of...
Courtesy of Dr. Carlos Fava. Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility. When it happens in frail patients, it presents a challenge. This population is on the rise and there is...
Current models are not reliable when it comes to predicting events after carotid revascularization in acute patients. Peri-procedural events seem to be particularly hard to predict. The development of models that can be externally validated is essential for the decision-making process in patients with high event rates, both during the procedure or while the case...
Left main coronary artery bifurcation interventions have shown very good results at long term, especially with new generation DES. The one-stent strategy has seen better results than the two-stent strategy, according to this registry recently published in J Am Coll Cardiol Intv. However, how does this registry of the daily practice between the years 2002 and...
The EXCEL study, originally presented at TCT 2016 and published simultaneously in the New England Journal of Medicine (NEJM), showed that angioplasty and surgery in patients with left main coronary artery disease have similar rates of mortality, infarction, and stroke at 3 years. This sub-study, recently published in J Am Coll Cardiol Intv, adds that the...
Noradrenaline (or norepinephrine) seems a safer choice than adrenaline (epinephrine) in patients undergoing acute myocardial infarction complicated with cardiogenic shock, according to the outcomes of this randomized study. Patients receiving adrenaline more often developed refractory shock, which led to early termination of this study. The administration of adrenaline was associated to over increased cardiac rate,...
Courtesy of Dr. Carlos Fava. The current population of frail and elderly patients is increasing, and while non-ST-segment acute coronary syndrome (NSTEACS) guidelines recommend early invasive treatment, this group has been excluded from most studies on the subject. Current information on its efficacy is controversial but agrees with the notion that this is a higher-risk group...
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...