Many patients arrive to the cath lab for a diagnostic coronary angiography after an echo showing severe ventricular dysfunction, even in asymptomatic patients. In many occasions, their coronary arteries are normal, and in many others, we find coronary disease that is not enough to warrant such severe ventricular dysfunction. Patients with heart failure are frequently…
Asymptomatic Coronary Artery Disease, Silent Ischemia: A Cardiologist’s Headache
We need more evidence to guide us in the management of silent ischemia. Confirmed asymptomatic coronary artery disease is a problem for cardiologists, who lack enough evidence to guide a risk-benefit assessment that justifies revascularization. Revascularizing the outcome of a functional assessment may reduce the rates of death and infarction, or it may just be…
The “Ten Commandments” of Myocardial Revascularization According to Europe
The new European guidelines on myocardial revascularization were developed by a joint effort of the European Society of Cardiology (ESC) and the European Association of Cardiovascular Surgery (EACTS). These guidelines are intended to support clinical practice with pragmatic recommendations based on currently available evidence and on personal experience, whenever evidence is missing. Both coronary angioplasty…
The 10 most consulted articles at SOLACI during 2018
1- New High Blood Pressure Guidelines The wait is finally over: the high blood pressure guidelines that have been in the works for the past 3 years saw the light of day at the American Heart Association (AHA) 2017 Scientific Sessions. Read more 2- The 10 Commandments of ESC’s New STEMI Guidelines The authors…
Aspirin, Bleeding and Cardiovascular Events in Healthy Elderly
The ASCEND and ARRIVE trials -presented at the European Cardiology Congress and published in The New England Journal of Medicine (NEJM) and The Lancet respectively- have put against the ropes the indication of aspirin in the context of primary prevention. The ASPREE trial, recently published in the NEJM, appears to have definitely overthrown aspirin, since…
Coronary Disease in Diabetes: Diabetic Patients Have Much Greater Plaque Progression
Patients with diabetes mellitus experience significantly greater plaque progression, particularly regarding adverse plaque. Male sex and baseline plaque volume >75% were identified as independent risk factors for plaque progression; the latter actually tripled the risk. This study with tomographic follow-up sought to determine the rate and extent of plaque progression, changes in plaque features, and…
AHA 2018 | No Benefits with Methothrexate as Anti-Inflammatory Drug
Low-dose methotrexate (a nonspecific anti-inflammatory agent used for the treatment of rheumatoid arthritis and other autoimmune disorders) did not prevent cardiovascular events in patients with a prior infarction or multivessel coronary artery disease, according to this study presented at the American Heart Association (AHA) Congress and published simultaneously in the New England Journal of Medicine…
AHA 2018 | New Physical Activity Guidelines Recommend Movement for All Ages
The new 2018 physical activity guidelines continue to recommend the same amount of physical activity (300 minutes of moderate-intensity physical activity per week or 150 minutes of vigorous-intensity physical activity), but they have changed which adults can carry out this moderate- and vigorous-intensity physical activity. Additionally, instead of recommending a target number of minutes of exercise per…
AHA 2018 | Freedom Long-Term Follow-up: Still in Favor of CABG
Nearly 8 years later, CABG maintains its benefit over PCI-DES in terms of mortality in diabetic patients with multivessel disease, according to the Freedom trial, presented by Dr. Fuster at AHA and simultaneously published in JACC. CABG is superior to PCI-DES, with 36% higher mortality in these last years. Considering the nature of atherosclerosis,…
Discharge During the Weekend After Cardiac Surgery Is Not Associated with Readmissions
According to this new work (soon to be published in Ann Thorac Surg), discharging a patient during the weekend or a holiday after cardiac surgery is not associated with higher rates of readmission compared with patients discharged during weekdays. A total of 4877 patients were discharged after cardiac surgery in high-volume sites in the United States. Among them,…