Courtesy of Dr. Carlos Fava. Primary coronary angioplasty has been the treatment of choice for acute myocardial infarction (MI) for many years, but such strategy is associated with nonculprit lesions in a large group of patients. While it has been proven that nonculprit-lesion revascularization offers better outcomes, the groups that would benefit from it are…
Staged Complete Revascularization vs. Culprit Vessel PCI at Long-Term
Staged complete revascularization in patients with acute myocardial infarction and multivessel coronary disease is superior to culprit PCI only at five-year follow-up. The outcomes of this retrospective analysis show the benefit of staged PCI, though it might be attenuated in diabetic patients. Outcomes are consistent with previously published randomized studies. Nevertheless, we should remain cautious…
Complete Revascularization Improves Long-Term Prognosis in Acute Coronary Syndromes
Going beyond the culprit artery during angioplasty was associated with lower mortality, although this was a cohort study that should be confirmed through randomized trials. According to this new observational study, patients experiencing non-ST-segment elevation myocardial infarction with multivessel disease seem to benefit from complete revascularization during initial angioplasty. This study, published online before…
EuroPCR 2018 | Compare-Acute: FFR or Primary Angioplasty at a 2-Year Follow-Up After Complete Revascularization
Recent studies in patients undergoing acute myocardial infarction showed that a complete revascularization strategy in an acute or subacute setting, whether it be guided through angiography (PRAMI, CvLPRIT) or fractional flow reserve (FFR) (PRIMULTI, COMPARE-ACUTE), improves the combined endpoint of major adverse cardiac events (MACE) when compared with treatment of the culprit artery only. Based…
Do the Best Coronary Revascularization Prior TAVR
The presence of coronary artery disease (CAD) in patients with aortic stenosis is high, reaching 50% to70% of cases. This poses a great challenge as to what strategy to use and the things we can do. Even though it has been shown complete revascularization is beneficial, it is often difficult to achieve. Instead, reasonable incomplete…
Complete Revascularization Is Beneficial in Acute MI with Cardiogenic Shock
Around half of all cases of ST-segment elevation acute myocardial infarction (STEMI) come alongside lesions in another vessel, for which the current strategy is complete revascularization in one or two steps. However, there are no large-scale studies analyzing patients who also present cardiogenic shock; we only have observational studies with inconclusive results influenced by several…
Incomplete Revascularization Does Not Mean the Same Thing for All Patients
Several studies show that patients with multivessel lesions who undergo angioplasty with incomplete revascularization experience more events, including higher mortality, than a cohort of patients who have undergone complete revascularization. In most cases, the analysis was dichotomic (complete vs. incomplete revascularization), but more recent studies show that there may be a gradient, a continuum, in…
The CULPRIT-SHOCK Study Is Finally Published in NEJM and It Is Bound to Change Guidelines
During SOLACI’s coverage of the TCT 2017 Congress in Denver, Colorado, we already mentioned some of the outcomes of this study that has arrived to revolutionize clinical practice, given the differences between its results and those of the classic SHOCK trial, which has marked for almost 20 years the treatment strategy for patients with infarction complicated…
FFR-Guided ACS Revascularization Apparently Superior to Culprit Vessel Treatment
Using fractional flow reserve (FFR) to guide revascularization of all functionally significant lesions in the setting of acute coronary syndrome appears to improve outcomes over treating only the culprit artery, according to the Compare-Acute trial. This study, conducted at 24 centers in Europe and Asia, enrolled 885 patients who were stable following successful primary angioplasty and…
Non-Cardiac Surgery with Incomplete Revascularization, Associated to Events
This study presented at the American Heart Association Scientific Sessions 2016 and simultaneously published in the Journal of the American College of Cardiology, showed incomplete revascularization is associated with an increased risk of adverse cardiac events, particularly infarction, in patients that must later receive non-cardiac surgery. Patients with incomplete revascularization (defined as a ≥ 50% left…