The aim of revascularization, whether through angioplasty or surgery, is to restore adequate flow to the myocardium; that much is obvious. However, after millions of “successful” procedures with the best technology applied to drug-eluting stents and optimal medical treatment, we still have a high ratio of patients who experience new events. Could an optimal angiographical…
Should Post-PCI Biomarkers Elevation Be of Concern?
Elevated markers after PCI in stable patients treated with the latest generation stents continues to happen. However, only the association between biomarker elevation with creatine kinase-myocardial band (CK-MB) should be of concern, sin it was associated with mortality at one year. Post procedural cardiac troponin (cTn) elevation was not associated to future events, according to…
Discordance Between FFR and iFR. Which Measurement Is More Important?
In the next days, Dr. Seung Hun and colleagues will publish in J Am Coll Cardiol Intv 2019 a study that answers the title question and also brings peace of mind about the decisions we make based on one of these measurements or the other. This study assessed the physiologic characteristics of discordant lesions between…
TCT 2019 | IVUS-XPL: 5-Year Follow-up for Angiography-vs. IVUS-Guided Angioplasty
Courtesy of SBHCI. The aim of this work, which was presented during the TCT 2019 Scientific Session and simultaneously published in JACC Intv, was to prove the benefit of intravascular ultrasound (IVUS) in angioplasty. The IVUS-XPL trial randomized 1400 patients with long coronary lesions (≥28 mm) to IVUS-guided angioplasty (n = 700) vs. angiography-guided angioplasty (n = 700). All procedures were…
TCT 2019 | AUGUSTUS ACS: Apixaban vs. Warfarin and Aspirin vs. Placebo in AF and ACS
Courtesy of SBHCI. The safety and efficacy of antithrombotic and antiplatelet treatments in patients with atrial fibrillation admitted with acute coronary syndrome (who receive medical treatment or angioplasty) may vary from that in patients undergoing elective treatment. At 14 days from elective angioplasty or hospitalization due to acute coronary syndrome, patients were randomized in a 2×2…
Theoretical Advantages Translated into Worst Clinical Outcomes: Synergy vs. Xience
New data from a real-world registry soon to be published in J Am Coll Cardiol Intv suggest that Synergy (a thin-strut everolimus-eluting stent with a biodegradable polymer) is associated with a higher risk of acute stent thrombosis when compared with classic Xience (a thicker-strut everolimus-eluting stent with a durable polymer). At 12 months, there was…
ESC 2019 | CLARIFY: Symptoms Predict Risk Only in Patients with Prior MI
The 5-year follow up of patients with chronic stable angina (or as the guidelines currently call it “chronic coronary syndrome”) indicate the risk of cardiovascular death or non-fatal MI is quite low, but risk factor control is still fairly poor. This information comes from the CLARIFY study, presented at ESC 2019 and published simultaneously in…
ESC 2019 | SYNTAXES: Ten-Year Outcomes!
The SYNTAXES (SYNTAX Extended Survival) was presented at ESC 2019 with somewhat unexpected results in favor of PCI. This is why the SYNTAX continues to be one of the best studies interventional cardiologists can rely on. The original SYNTAX tested mortality (primary end point) with PCI vs. CABG in patients with multivessel and/or left main…
ESC 2019 | AFIRE: Monotherapy with Rivaroxaban in Atrial Fibrillation and Stable CAD
In patients with atrial fibrillation and stable coronary artery disease who have not had revascularization procedures in the last 12 months, monotherapy with rivaroxaban seems the best treatment strategy compared to rivaroxaban plus antiplatelet antiaggregation. This is what resulted from the AFIRE study, presented during the ESC 2019 in Paris and published in NEJM. Monotherapy…
ESC 2019 | THEMIS: Ticagrelor in Diabetics with Stable Coronary Artery Disease
The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable. Primary end point rate (composite of cardiovascular death,…