The use of morphine in patients undergoing ST elevation acute coronary syndromes is associated to higher platelet reactivity and lower thrombolysiscapacity, according to this small study. The negative effects seem to resolve 2 days after administration. This transient effect is believed to be the result of the inhibition of the normal muscular activity of the…
EARLY-BAMI: Metropol Showed No Reduction in Infarct Size.
EARLY-BAMI outcomes show the endovenous administration of metropol before primary PCI does not reduce infarct size. This double blind study randomized 683 STEMI patients within 12 hours of symptom onset to endovenous metropol (two 5 mg bolus, the first in the ambulance and the second before PCI) vs. placebo. Primary end point was infarct size…
New Meta-Analysis Shows Similar Mortality between Bivalirudin and Heparin
This meta-analyzis of contemporary studies comparing the safety and efficacy of bivalirudin vs. heparin showed no differences in mortality between the two drugs and, consistently with other studies, bivalirudin was associated with an increased risk of acute stent thrombosis. During ACC 2015, the MATRIX study did succeed in showing global differences between the two drugs…
Immediate vs. Delayed Stenting in Primary PCI
Original Title: Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction. The MIMI Study. Reference: Loic Belle et al. Circ Cardiovasc Interv. 2016 Mar;9(3). Delayed stenting after normal epicardial flow restoration is meant to lower the chance of distal embolization and to improve reperfusion in the…
Which intraprocedural thrombotic events impact PCI outcomes
Original Title: Which Intraprocedural Thrombotic Events Impact Clinical Outcomes After Percutaneous Coronary Intervention in Acute Coronary Syndromes? A Pooled Analysis of the HORIZONS-AMI and ACUITY Trials. Reference: Jeffrey D. Wessler et al. JACC Cardiovasc Interv. 2016 Feb 22;9(4):331-7. Courtesy of Dr. Agustín Vecchia. Intraprocedural thrombotic events (IPTEs) indicate short and term prognosis in PCI patients. This…
Survivors of Myocardial Infarction with Cardiogenic Shock: Long Term Outcomes.
Título original: Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock Findings From the NCDR. Referencia: Rashmee U. Shah et al. J Am Coll Cardiol. 2016;67(7):739-747. Even though mortality after cardiogenic shock MI is quite high, many survive and are discharged. So far, there is little we know about their prognosis after discharge.…
Immediate vs. delayed intervention in non-ST-elevation myocardial infarction
Original Title: Immediate Versus Delayed Invasive Intervention for Non-ST-Segment Elevation Myocardial Infarction Patients The RIDDLE-NSTEMI Study (Randomized study of ImmeDiate versus DeLayedinvasivE intervention in patients with Non-ST-segment Elevation Myocardial Infarction). Reference: J Am CollCardiolIntv. 2016. Online before print. This study assessed the clinical impact of immediate invasive intervention (within 2 hours) vs. delayed intervention (within…
FFR in non-ST elevation myocardial infarction
Original Title: Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-St segment elevation myocardial infarction: the British Heart Foundation FAMOUS–NSTEMI randomized trial. Reference: Jamie Layland et al. European Heart Journal (2015) 36, 100–111 Courtesy of Dr. José Amadeo Guillermo Álvarez. Several studies have established the value of fractional flow reserve (FFR) in…
Primary PCI with Bioresorbable Vascular Scaffolds
Original Title: One-year Clinical and Computed Tomography Angiographic Outcomes after Bioresorbable Vascular Scaffold Implantation during Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. The Prague-19 Study. Reference: Widimsky P et al. Circ Cardiovasc Interv. 2015 Dec;8(12). Courtesy of Dr. Carlos Fava. Primary PCI is the most common course of treatment for ST elevation myocardial infarction (STEMI)…
Ticagrelor vs Clopidogrel in low risk coronary syndrome
Original Title: Effects of Ticagrelor versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI. Reference: Dominick J et al. J Am Coll Cardiol. 2016;67(6):603-613. Many patients admitted with low-risk acute coronary syndrome (ACS) are not pre-treated with a P2Y12 receptor inhibitors despite the invasive strategy in place, with angiography and PCI in the…