Lecture by Dr. Hector García García – LM-PCI: IVUS and FFR/IFR? Dr. Hector García delivered an excellent presentation on whether we should use intravascular ultrasound (IVUS) or fractional flow reserve (FFR)/instantaneous wave-free ratio (iFR) in the left main coronary artery (LMCA) to consider severe obstruction, since there is significant interobserver variability with angiography. Although the...
Percutaneous left atrial appendage closure (LAAO) with Watchman has FDA approval since March 2015, having shown, in the PROTECT-AF and PREVAIL studies, reduced risk of atrial fibrillation driven stroke, by excluding the left atrial appendage form systemic circulation. Both studies used post procedure standardized protocols involving followup at 45 days and 6 months, imaging, and...
Dual antiaggregation therapy (DAPT) with ASA and P2Y12 during 6 to 12 months is the indicated strategy after DES stenting to reduce ischemic events. However, in patients with elevated risk of bleeding (HBR) guideline and expert recommendations is 1-6 months, since there is plenty of evidence in favor, except for a randomized study, the MASTER...
There is a consistent number of patients presenting high risk of bleeding. In this context, receiving dual antiplatelet therapy (DAPT) for 12 months would not be advisable. Even though the European and American guidelines recommend 1 to 6 months for chronic and acute syndromes in this group, these are often complex PCI cases, which makes...
The incidence of left ventricular thrombosis (LVT) after anterior ST-segment elevation myocardial infarction (STEMI) ranges from 4% to 26%. This is associated with bad long-term evolution. In the past, triple-scheme therapy (vitamin K antagonist plus dual antiplatelet therapy) was recommended to prevent LVT, despite the lack of high-quality scientific evidence and an increase in the...
Much has been published recently on short term dual antiplatelet therapy (DAPT) both in acute (ACS) and chronic coronary syndrome (CCS) as well as safety of P2Y12 inhibitor monotherapy. When discussing secondary prevention in patients with established coronary artery disease, aspirin (ASA) has been the preferred drug for the prevention of new atherothrombotic events. This...
Left atrial appendage occlusion (LAAO) is an alternative to prevent atrial fibrillation stroke mainly used in patients at high risk for bleeding. One of the most widely used devices in randomized trials is the Watchman, which yielded promising results. However, its real-life performance had yet to be analyzed. Researchers conducted an analysis of the National...
DAPT-TAVR is a randomized trial that tested endoxaban in patients with no indication for anticoagulation who underwent successful transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis. This study included 229 patients whose mean age was 80 years; 42% of them were male. Patients were randomized to either endoxaban 60 mg or 30 mg every 24 h or...
Dual antiplatelet therapy (DAPT) after PCI with DES has shown noticeable reduction of thrombotic events, especially in acute coronary syndromes (ACS). However, this therapy encompasses increased bleeding, especially in elderly patients increasingly undergoing percutaneous intervention. Even though most bleeding events might not be fatal (many of them are mostly digestive) they do involve higher hospitalization...
Compared with patients with chronic coronary syndromes, patients with acute coronary syndromes (ACS) are more likely to suffer from long term major adverse cardiac events (MACE). To prevent this, both the American and the European guidelines recommend prolonging dual antiplatelet therapy (DAPT) in this population for at least 12 months. However, in patients with certain clinical...