Courtesy of SBHCI. Both fractional flow reserve (FFR) and optimal coherence tomography (OCT) can be useful to help define intermediate coronary lesions and optimize PCI outcomes. The FORZA study presented at San Francisco TCT 2019 scientific sessions simultaneously published in JACC randomized patients with intermediate lesions 1:1 to FFR vs OCT. For the FFR arm,...
Drug Coated Balloons vs. Drug Eluting Stents in Primary PCI
There might come the time when we are finally able to leave nothing behind, at least in the context of primary PCI. The REVELATION study, soon to be published in J Am Coll Cardiol Intv, has shown that paclitaxel coated balloons resulted non inferior to drug eluting stents (DES) in terms of FFR (fractional flow...
Is Complete Revascularization the Right Choice in Acute Myocardial Infarction with Multivessel Disease?
Courtesy of Dr. Carlos Fava. Primary coronary angioplasty has been the treatment of choice for acute myocardial infarction (MI) for many years, but such strategy is associated with nonculprit lesions in a large group of patients. While it has been proven that nonculprit-lesion revascularization offers better outcomes, the groups that would benefit from it are...
ESC 2019 | COMPLETE: Definitive Evidence for Infarction with Multivessel Disease
For patients with ST-segment elevation acute myocardial infarction and multivessel disease beyond the culprit artery, complete revascularization is superior to culprit-only treatment as regards the final endpoint, a composite of cardiovascular death, infarction, and ischemia-driven revascularization over a mean follow-up of 3 years. This information derives from long-awaited randomized study COMPLETE, finally presented at the...
FFR to Predict CABG Result: All Benefits in a Population Much Too Pure?
Coronary artery bypass graft (CABG) anastomosed to one vessel with normal or nearly normal fractional flow reserve (FFR) have poorer graft patency at one year compared against anastomosed grafts to vessels with functionally significant lesions shown by FFR. However, the recent study FARGO (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization) did not show...
Functional Assessment of Lesions: Advances with MRI
Computer tomography (CT) had taken over in the race to develop software capable of measuring FFR non-invasively. Magnetic resonance imaging (MRI) wouldn’t fall behind and has also tried non-inferiority vs an FFR based strategy, according to this study recently published in the prestigious NEJM, called MR-INFORM. In patients with chronic angina and CAD risk factors,...
EuroPCR 2019 | REVELATION: Drug Coated Balloons in ST Elevation MI
Drug coated balloons in the context of ST elevation acute myocardial infarction seem safe and feasible under certain circumstances. This single center study is the kickoff to keep studying the possibility of “leaving nothing behind” after primary PCI. This small randomized study revives drug coated balloons to be used particularly instead of stents in young...
Angiography Guided CABG Still Adequate
Fractional Flow reserve (FFR) guided myocardial revascularization surgery (CABG) has similar graft failure rate and clinical outcomes as angiography guided CABG. When planning PCI, the value of FFR for lesion assessment pose no questions, but we know little when it comes to CABG. Since the early start, back when Dr. Mason Sones performed catheterizations and...
Angiography-Derived FFR: Complicated Software or Imminent Reality?
Angiography-derived fractional flow reserve (FFR) demonstrated substantial usefulness, especially in patients with three-vessel lesions. The functional SYNTAX score derived from angiography has the potential to redefine prognosis and treatment strategies compared with the classic anatomical SYNTAX score. This study sought to investigate the applicability of this method in patients with multivessel lesions included in the...
Clinical Events after Deferral of LAD Treatment Guided by FFR or iFR
iFR is a safe alternative for lesion deferral even when it comes to the left anterior descending artery (LAD). What is more, patients deferred with iFR showed significantly fewer events than patients deferred using FFR. Neither clinical cardiologists nor interventionists feel comfortable deferring LAD treatment, because it is often perceived as high risk. If functional...