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…
Post MI Betablockers for Good?
Patients receiving optimal medical treatment after MI do not seem to benefit from betablockers in the long term, provided they do not present cardiac failure or systolic function deterioration. This study looked into the cardio protection effect of betablockers (BB) after long term follow up in stable patients with no cardiac failure and a history…
Ticagrelor: Yet Another Pleiotropic Effect?
Studies in animals have shown ticagrelor offers better myocardial protection against reperfusion injury after ST elevation MI than clopidogrel. This had to be tested in the clinical arena, which is the aim of this study (published in JACC Intv): to assess left ventricular remodeling after reperfusion. The study included patients undergoing their first ST elevation…
Pleiotropic Effect of Metoprolol: Different From other B-blockers
The clinical practice guidelines recommend the early use of endovenous B-blockers in patients undergoing acute myocardial MI, taking for granted that all B-blockers have a similar class effect. This experimental study might show metoprolol has other benefits that could make it superior to the rest of the B-blocker family. Using an animal model with 45-minute…
The Transradial Approach Continues to Be the Best for Primary PCI
The transradial approach has been associated to lower mortality and bleeding rates in patients receiving primary PCI for ST elevation MI. This had been called into question by the recent SAFARI-STEMI, but after including its outcomes in a new meta-analysis, the scales tilted slightly in favor of the transradial approach vs. the transfemoral. The transradial…
Antiplatelet Therapy in Elderly Population: Are the New P2Y12 Inhibitors Safe?
Should elderly patients stick to clopidogrel? The first large study on prasugrel showed an unacceptable increase of bleeding in elderly patients, suggesting the use of 5 mg (although the sample size was small, which hindered the determination of dose efficacy). Later, ticagrelor showed better efficacy than clopidogrel without apparent safety concerns. However, specific evidence on elderly…
Ticagrelor or Prasugrel in ST Elevation MI
In patients undergoing ST elevation acute myocardial infarction (STEMI) receiving primary PCI, no significative differences between prasugrel and ticagrelor were found. However, the latter was associated to a significantly higher number of repeat MI when considered separately. Few studies have compared the efficacy and safety of the two most potent oral P2Y12 receptor inhibitors in…
TCT 2020 | Crushed Prasugrel Administration prior PCI
Prehospital administration of crushed tablets of prasugrel loading dose in the ambulance while patient is on his way to primary PCI does not improve reperfusion markers compared against uncrushed tablet administration according to the COMPARE CRUSH, presented at the virtual TCT 2020 and simultaneously published in Circulation. There were no differences in TIMI flow of…
Visual Assessment for Non-Culprit Lesion Revascularization
There is evidence in favor of complete revascularization in the context of ST elevation MI with multivessel disease where primary PCI has been successful. However, the small print in these studies should be read carefully. Should revascularization be completed during index intervention, index hospitalization or after discharge? Should complete revascularization be based on visual assessment,…