Sirolimus-eluting stents with biodegradable polymer did not offer better outcomes compared with instant-classic (and undoubtedly valid) everolimus-eluting stents with durable polymer such as Xience. New-generation drug-eluting stents (DES) offer better outcomes than first-generation devices after a 10-year follow-up, according to the ISAR-TEST 4 trial presented at the American Heart Association (AHA) Congress Scientific Sessions and published...
Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously...
Published 5-year results had been neutral for bilateral vs. single internal-thoracic artery grafts, but, at the time, surgeons argued that the time period analyzed was not enough and that a difference would be observed after 10 years of follow-up, once the trial finished. Such follow-up was presented at the European Society of Cardiology (ESC) Congress 2018...
The EXCEL trial did not find the sex of patients with left main coronary artery disease to be an independent predictor of adverse events after revascularization. However, women who underwent angioplasty had a trend towards worse outcomes, a finding that might be related to comorbidities and somewhat increased chances of peri-procedural complications. In its formal...
The prognosis of patients with symptoms of angina (with all their subjectivity) in a setting of no significant coronary lesions is widely varied. It is not as benign as we initially thought and patients do not present as many events as “regular” patients with associated severe coronary lesions. The literature owed us data on the...
Courtesy of Dr. Carlos Fava. The incidence of kidney disease is increasing. In its final stage, this pathology is related with coronary disease and increased mortality. Furthermore, we know that, in many occasions, it is associated with diabetes. Nowadays, the evidence comparing the progress of patients with impaired kidney function who have undergone left main...
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of...
Long-term follow-up of patients under 50 with multivessel coronary artery disease suggests surgery outcomes are significantly better than angioplasty outcomes. This study, presented at the Society of Thoracic Surgeons’ (STS) Annual Meeting, concludes that surgery should continue as plan A when it comes to young patients with three-vessel disease. Surgeons complain that many patients never actually...
The results of the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial have shown a lower rate of events in patients with diabetes and stable multivessel disease who were randomized to undergo myocardial revascularization surgery, compared to those who underwent angioplasty. Surgery even showed a mortality reduction that...
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...