The FLOWER-MI (presented simultaneously at ACC 2021 and NEJM) hit FFR hard. Its outcomes showed that STEMI patients presenting other non-culprit lesions did not benefit from FFR guided revascularization vs PCI. As it happens with most large studies with unexpected results in the general population, the sub-studies that follow select better samples and, as a…
ESC 2021 | COVERT-MI: Colchicine Attempts to Reduce Infarct Size
Colchicine does not offer protection against myocardial injury in ST-segment elevation myocardial infarction when administered during reperfusion and in the following five days, according to the randomized study COVERT-MI. It could even generate signs of damage with 3x the amount of thrombi in the ventricle. The results presented at the European Society of Cardiology 2021…
Complete Revascularization after Pharmacoinvasive Strategy
Patients initially receiving pharmacoinvasive strategy for ST elevation myocardial infarction (STEMI) also presenting multivessel disease consistently benefit from complete revascularization. This benefit is similar to that of primary PCI. The COMPLETE showed that staged non-culprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular events in STEMI patients with multivessel coronary artery disease. This benefit was…
FLOWER-MI: FFR vs. Angiography for Complete Revascularization in Infarction
Functional assessment with fractional flow reserve (FFR) was not better than conventional angiography to guide complete revascularization in patients with multivessel lesions in a setting of ST-segment elevation myocardial infarction and successful primary angioplasty. These results were published in the New England Journal of Medicine (NEJM) and presented during the American College of Cardiology (ACC)…
EuroPCR 2021 | CELEBRATE-02: Novel Glycoprotein IIb/IIIa Inhibitor for ST-Segment Elevation Infarction
Promising fast subcutaneous administration and a quick and potent antiplatelet effect, here comes a novel glycoprotein IIb/IIa inhibitor called RUC-4. This novel drug was tested in the CELEBRATE-02 study, presented at EuroPCR 2021 and simultaneously published in EuroIntervention. The mean platelet inhibition begins 15 minutes after injection and increases with each of the three tested doses…
ACC 2021 | TALOS-AMI: De-escalating from Ticagrelor to Clopidogrel after One Month
After one-month dual antiplatelet therapy (DAPT) with aspirin and ticagrelor, a net clinical benefit was observed when de-escalating to clopidogrel in acute myocardial infarction (AMI) patients treated with PCI. We have discussed the pros and cons of de-escalating from a potent antiplatelets Such as ticagrelor to clopidogrel since the TOPIC presented at EuroPCR in 2017. What…
ACC 2021 | Sacubitril/Valsartan not Superior to Ramipril after AMI
The combination sacubitril/valsartan following high-risk AMI did not reduce the risk of cardiac failure or cardiovascular risk in patients compared against ramipril. These data were provided by the PARADISE-MI presented today during the scientific sessions at ACC 2021. The combination sacubitril/valsartan had gathered prior evidence (basically from the PARADIGM-HF) for its superiority in terms of total…
ACC 2021 | Emergent CABG for acute MI: Benefits Despite Risk
The latest figures show a lower number of emergency CABG for acute MI, and in turn increased primary PCI. The combination of surgeons not willing to take risks and interventional cardiologists empowered to treat practically any lesion has resulted in fewer patients receiving emergency CABG. Only a few years ago, interventional cardiologists at least had…
ACC 2021 | Stress Increases Events in Young Patients with Prior MI
Young or middle-aged patients who have already suffered a heart attack have almost twice as many adverse events when they continue to be under emotional stress after the initial suffering. The association between psychological factors and events is attenuated after making adjustments that include markers of inflammation such as interleukin-6. It follows that inflammation plays…
New Unexpected Data on Non-Culprit Vessels in MI
Patients with acute myocardial infarction presenting lesions in multiple vessels is not associated with reduced infarct size in non-culprit lesions, even when functionally significant. Animal models suggest brief periods of ischemia in non-infarct territories (non-culprit) might protect culprit territory thanks to remote ischemic preconditioning. This pre-conditioning, according to this perspective, would reduce reperfusion injury and…