The high platelet reactivity is associated with adverse events after stent implantation. Current guidelines consider the measurement of aggregability as a class IIB and there is no information about the routine performance of these measurements. This was a multicenter, prospective, randomized study that included 3800 patients with myocardial infarction. The primary study end point was...

The HORIZONS AMI trial showed the usefulness of bivalirudin in reducing mortality and bleeding compared with the use of heparin plus glycoprotein IIBIIIA. However, some questions remained unanswered: What is the utility of starting the infusion during the ambulance journey? Is it possible to reduce the risk of acute thrombosis by extending bivalirudin infusion or...

Contrast nephropathy is associated with increased morbidity and so this study evaluates the possibility of reducing the required necessary volume of contrast  using coronary intravascular ultrasound (IVUS). Patients were randomized to IVUS  guided angioplasty (n = 41) and angiography guided angioplasty (n = 42). IVUS-guided angioplasty requires a smaller volume of contrast (22.9 ± 12.5...

Currently the recommendation is 12 months of dual antiplatelet after a drug-eluting stent angioplasty. This study compared the 3 – months versus 12 months of dual antiplatelet  after angioplasty with zotarolimus-eluting stent in real-world patients. This was a prospective, multicenter study randomized 1563 patients to receive aspirin and clopidogrel for 3 months and 1556 to...

The aim of this study was to evaluate the clinical impact resistance thienopyridines through genetic analysis of CYP2C19 receptor. The primary endpoint was  a combination of mortality, myocardial infarction, stent thrombosis in the resistance group (few responders) versus non-resistant (responders) to the thienopyridines. 1445 patients were included of which 22% were considered few responders. There...

Hypothermia improves myocardial ischemia in animals but studies in humans failed to demonstrate benefit to that extent.We admitted 120 patients experiencing anterior-posterior STEMI with up to 6 hours after onset, randomized to conventional invasive therapy versus conventional invasive therapy associated with hypothermia. The primary endpoint was infarct size by MRI at 4 days.There was no...

This study randomized 1259 patients to receive one year versus 2 years of double anti anti-platelet after implantation of a drug-eluting stent. The primary end point was a composite of death, myocardial infarction, stroke, stent thrombosis, and urgent revascularization that were equivalent between the two schemes. There was a trend to a higher rate of...

This prospective randomized study compared aggressive revascularization angiography injuries 50% versus a most conservative revascularization lesions>70%.The primary end point was death, myocardial infarction and recurring revascularization. We included a total of 889 patients (449 in the aggressive revascularization group and 450 in the conservative revascularization group).No differences in major cardiac events between the two groups...

Bivalirudin reduced mortality and bleeding compared to heparin and glycoprotein IIbIIIa in HORIZONS- AMI study. However there was a higher rate of acute stent thrombosis in patients receiving bivalirudin. This randomized study (> 90 % randomized in the ambulance) enrolled 2218 patients with ASTEMIto prolonged infusion of bivalirudin compared with heparin -associated glycoprotein inhibitors. The...