Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full...
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. ...
Aortic stenosis increases afterload creating hypertrophy as a compensation mechanism to maintain minute volume. This leads to left ventricular diastolic dysfunction (LVDD). More than half of patients presenting aortic stenosis have LVDD and myocardial fibrosis, which is a mortality predictor in surgery. At present, there is contradicting evidence in TAVR. The study looked...
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...
A mean gradient ≥40 mmHg, an aortic valve area ≤1 cm², or a combination of both, during dobutamine stress echocardiography, correctly qualifies as severe aortic stenosis in about half of all patients. The other half consists in cases of pseudo-severe aortic stenosis. In turn, a projected aortic valve area ≤1 cm² is a much better indicator than the...
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...
TAVR has shown benefits in high risk patients (prohibitive) and in intermediate risk patients, but the need for permanent pacemaker implantation (PPI) continues to be a soft spot (especially in younger patients) given time of use, eventual replacement and associated complications. Even though there is little information on PPI, pacemakers are not associated with higher mortality, but they...
Next-day discharge after transfemoral transcatheter aortic valve replacement (TAVR) might be viable, with no major complications at 30 days or one year, compared against patients with longer hospital stay. We only have to consider a few factors that will help us choose the most adequate patients for this modality without compromising safety. One of the main advantages...
Around half of all cases of ST-segment elevation acute myocardial infarction (STEMI) come alongside lesions in another vessel, for which the current strategy is complete revascularization in one or two steps. However, there are no large-scale studies analyzing patients who also present cardiogenic shock; we only have observational studies with inconclusive results influenced by several...