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...
Peri-Procedural Infarction in Angioplasty vs. Surgery in the Left Main Coronary Artery
According to the EXCEL trial, peri-procedural infarction was more common after left main coronary artery surgery compared with angioplasty, and it was strongly associated with increased 3-year mortality after controlling all possible confounding variables. This increased mortality was only present in extensive infarctions with an increase in CK-MB ≥10×. The EXCEL trial seems to want...
Bariatric Surgery Associated with a Lower Rate of Mortality Due to Infarction and Stroke
Prior bariatric surgery in a patient with morbid obesity is associated with a significant effect on survival after infarction or stroke. While these are observational data, the significant metabolic improvement experienced after the surgery can explain perfectly such findings. This large nationwide registry of bariatric surgery found a 40% decrease in the risk of death,...
ACC 2019 | Having an Infarction at Very Young Age or 10 Years Later Does Not Change Long-Term Mortality
Patients who suffered their first coronary event before turning 40 years old have similar long-term mortality to those who experienced it even 10 years later, according to the YOUNG-MI Registry presented at the American College of Cardiology [ACC] 2019 Scientific Sessions. Secondary prevention must be used aggressively in both young and elder patients. Over more than...
The Ten Commandments for the Fourth Universal Definition of Infarction
The Fourth Universal Definition of Myocardial Infarction is a document developed jointly by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF). The Fourth Definition was necessary for multiple reasons, including increasingly higher troponin sensitivity. While troponin obviously does not...
The “Ten Commandments” of Myocardial Revascularization According to Europe
The new European guidelines on myocardial revascularization were developed by a joint effort of the European Society of Cardiology (ESC) and the European Association of Cardiovascular Surgery (EACTS). These guidelines are intended to support clinical practice with pragmatic recommendations based on currently available evidence and on personal experience, whenever evidence is missing. Both coronary angioplasty...
Myocardial Revascularization Surgery Hits a Plateau
Hopes were raised high by the ARTS study, when set to show the benefit of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery compared over the use of a single internal mammary artery (SIMA) at 10 year follow up, but only one sub-study was able to show an advantage over radial grafts....
High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things
Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. This document was presented a few days ago at the European Society of Cardiology (ESC) Congress in Munich and simultaneously...
ESC 2018 | CLARIFY: No Survival Benefit with Beta-Blockers Beyond 1 Year After Infarction
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...
EuroPCR 2018 | FFR Reduces Death and Infarction Rates Compared with Medical Treatment
Pooled data from the most important recently published studies (FAME 2, Compare-Acute, and DANAMI3-PRIMULTI) conclude that there is a significant difference in favor of fractional flow reserve (FFR) as regards hard endpoints. Coronary revascularization guided by FFR reduces the risk of death and infarction when compared with optimal medical treatment in patients with stable and...