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,…
EuroPCR 2019 | Global Leaders: Ticagrelor Monotherapy at Long Term Could Have a Role in Complex PCI
This post hoc analysis of what had been a trial with negative outcomes should be considered only as a hypothesis generator. Patients receiving complex PCI treated with ticagrelor monotherapy after one-month dual antiaggregation therapy (DAPT) showed better results at 2 years when compared against patients receiving a conventional DAPT scheme. In the global analysis, this…
PCI Right After CABG: How Bad Can it Be?
In-hospital PCI right after CABG is extremely rare, but it does increase morbidity, mortality and costs significantly. It is still unclear what predictors can be modified to prevent these very early angiography and angioplasty procedures in patients that generally leave the OR with visible EKG changes. Graft failure, distal vascular bed quality, technical error or…
ACC 2019 | STOPDAPT-2: P2Y12 Monotherapy After Short-Term Dual Antiplatelet Therapy After Angioplasty
Aspirin is against the ropes: first, it was primary prevention; now, its use is being reconsidered even in relation to angioplasty. There might be paradigm changes as regards antiplatelet therapy after angioplasty. These two studies presented at the American College of Cardiology (ACC) 2019 Scientific Session can really change what we have been doing unquestioningly…
ACC 2019 | SMART-CHOICE: Aspirin Increasingly “Against the Ropes”
This work (presented during the same American College of Cardiology [ACC] 2019 Scientific Session as the STOPDAPT-2 trial) enrolled 2993 patients who underwent angioplasty with current-generation stents Xience, Promus, Synergy, or Orsiro at 33 Korean sites. Patients were randomized to 12 months of dual antiplatelet therapy or dropping aspirin at 3 months. There was no difference between the short-…
ACC 2019 | AUGUSTUS: Apixaban Plus P2Y12 Inhibitor Is the Best Combination in Atrial Fibrillation and Angioplasty
Aspirin increases bleeding with no ischemic benefit, but a trend toward more stent thrombosis with placebo warrants further studies. Patients with atrial fibrillation who receive an anticoagulant agent and coronary angioplasty with a stent, and then continue with aspirin, experience an increased risk of bleeding without any ischemic benefit whatsoever. The use of a…
In Diabetics with Multivessel Disease SYNTAX Score Calculations Are Redundant
In diabetic patients with multivessel disease, anatomical complexity assessed by SYNTAX score is an independent predictor of combined events only por PCI patients, and has absolutely no consequence for surgery. The score should not be used to decide on a revascularization strategy. If the patient is diabetic and has multivessel disease, they simply ought to…