After a 5-year follow-up, and for the first time, functional assessment with fractional flow reserve (FFR) showed clear benefit for a hard endpoint: acute myocardial infarction. Use of FFR in patients with stable coronary artery disease so as to identify hemodynamically significant lesions in order to restrict angioplasty treatment to them has long-term benefits compared...
In patients with left main or three-vessel coronary disease, heart team decisions on revascularization strategy (angioplasty or surgery) may be made based solely on noninvasive computerized tomography (CT) angiography, since there is great correlation between its results and those determined by conventional angiography. For the SYNTAX III REVOLUTION study, Dr. Serruys and his colleagues randomized...
The SCAAR registry aimed at showing the differences in mortality at very long term when using functional assessment of coronary lesions (with FFR or iFR) in patients with chronic stable angina. The study compared 3460 patients assessed with FFR/iFR against 21221 patients undergoing PCI based on angiography, between January 2005 and March 2015. As...
Performing a successful primary angioplasty and prescribing preventive medication without advising on the importance of keeping up with or taking up physical activity is a waste of one of our many opportunities to improve the quality of life of our patients and reduce mortality among them. If clinical cardiologists do not take over the patient,...
Elective, uncomplicated repeat revascularization after stent restenosis is associated with higher mortality rates according to a new meta-analysis that will be published soon in J Am Coll Cardiol Intrv. Historically, interventional cardiologists have seen target lesion revascularization (TLR) as a procedure that “unjustly” increased combined events in clinical studies and our own databases, thus representing...
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...
For this Canada-based study, the increased number of patients who required a transcatheter aortic valve replacement (TAVR) may have come hand in hand with an equal increase in healthcare financing, so as to cover procedural costs. In spite of that, the wait-time between the formal request for authorization and the actual procedure was 3 months, and...
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. ...