The presence of a metallic device interrupts normal laminar flow and creates an artery environment that favors thrombosis, leaving the vessel vulnerable to very late thrombosis. Dual antiplatelet therapy, a better implantation technique, and several improvements in new drug-eluting stents (DES) (thinner struts, and higher polymer stability and biocompatibility) have lowered significantly the incidence of...
The fundamental advantage offered by transcatheter aortic valve replacement (TAVR) has always been the fact that it is less invasive than surgical valve replacement. So far, most improvements for these devices have derived in less invasiveness (e.g., by improving the profile of the eluting system). However, there are also cases of “deployment” reduction during the...
It seems that a LDL level of 70 mg/dL is no longer low enough for high-risk secondary patients; in consequence, this study attempted to set a new target, one that appears almost impossible to reach: 40 mg/dL or lower. This study, simultaneously presented at the European Society of Cardiology Congress 2017 and published in The Lancet, showed...
Fractional flow reserve (FFR) has proven to be superior to angiography as a guide to revascularization due to a significant reduction in the number of both long-term and short-term events. Furthermore, deferring treatment of lesions without evidence of ischemia offers an excellent prognosis. Many studies including mostly stable patients showed a significant degree (as high...
Patients who receive chronic anticoagulation therapy and then undergo angioplasty are frequently discharged on a triple anti-thrombotic scheme that usually includes aspirin, clopidogrel, and warfarin. The optimal duration of this indication remains unclear, particularly for patients at high bleeding risk. According to expert consensus, patients receiving chronic anticoagulation may receive from 1 to 12 months of dual...
Combining low doses of rivaroxaban and aspirin seems to be the best strategy for patients with stable chronic ischemic heart disease, according to this new study presented at the European Society of Cardiology Congress 2017, which was published simultaneously in the New England Journal of Medicine. Compared with low-dose aspirin alone, the combination of aspirin...
This new meta-analysis did not manage to prove whether permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR) raises the rates of mortality, infarction, or stroke. Implantation could only be associated to a lesser recovery of ventricular function after the procedure, something that had already been observed in previous studies. Patients who required a pacemaker undoubtedly...
Another important work that does not see the benefits of bivalirudin over heparin as monotherapy as regards both efficacy (death and MI) and safety end points (bleeding) in patients undergoing acute myocardial infarction with and without ST elevation. The study VALIDATE-SWEDEHEART, presented at ESC, simultaneously published in the New England Journal of Medicine, randomized 6000 patients...
Several randomized studies have shown that dual antiplatelet therapy (DAPT) is as effective to prevent thrombotic events in the segment treated with PCI, as it is with the rest of the coronary segments. This is very clear. The problem is there are a series of adverse events following P2Y12 inhibitor discontinuation. This phenomenon called rebound effect, happens...
The higher rate of restenosis in the diabetic population is historic and has been reproduced in all studies and with all kinds of stents, but it was only after the FREEDOM trial when we found out about the higher infarction rate with PCI compared to surgery. This is why 50% of patients undergoing CABG are diabetic. Apart from the above...