Post-discharge bleeding in patients admitted for acute coronary syndrome (ACS) is linked to higher all-cause mortality. However, this is the case for both patients who underwent angioplasty and those who were managed with medical treatment. These are interesting data, given that medical treatment is frequently preferred due to lower bleeding risk. Speculation is based on…
Peripheral Artery Disease: Underestimated and Undertreated
Compared against coronary artery disease (CAD) or cerebrovascular disease patients, peripheral artery disease (PAD) patients have lower chances of receiving medication proved to be clinically effective such as statins (despite running the same risk, perhaps even higher risk). The message is we should be more active both in finding risk factors in PAD patients, and…
EuroPCR 2020 | Revascularization vs. Initial Medical Treatment in Chronic Patients
There is no survival advantage with invasive coronary revascularization over initial medical treatment in patients with chronic coronary artery disease. However, revascularization did reduce the incidence of unstable angina and its symptoms, according to this new meta-analysis published in Circulation and presented virtually at EuroPCR 2020. There was no significant difference in spontaneous infarctions overall, but…
AHA 2019 | ISCHEMIA-CKD: Chronic Kidney Disease and Stable Coronary Disease
Among patients in the main ISCHEMIA trial, those with chronic kidney disease are a particularly high-risk subgroup. However, an invasive strategy with coronary angiography and revascularization did not improve the rate of events, similarly to what happened in the general population for the aforementioned trial. The rate of death or acute myocardial infarction was 36.4%…
STEMI in Coronary Dissections. When Should We Do It and What Are Its Outcomes?
Courtesy of Dr. Carlos Fava. Generally, coronary artery dissection (SCAD) is not very frequent in young women and presents better evolution with medical treatment. However, it is occasionally associated with ST segment elevation. In this scenario, PCI with stent implantation is quite challenging. The study looked at 4298 STEMI patients; 53 presented SCAD (1.23%). STEMI-SCAD…
Antianginal Medication Before and After Rechanneling
Escalation or de-escalation of antianginal medication was less common than treatment continuation without change after a chronic total occlusion rechanneling, with little variation according to the site. Further research is needed to identify patients who would benefit (or not) from these drugs and to develop strategies to adjust treatment during follow-up. This work basically tells…
The FDA Affirms Mortality Signs with Paclitaxel Based Devices
Evidently, we are still uncertain. The information goes both ways, even on our own web page, we have been coming and going just like any other publication around the world. After a 2-day debate, the Circulatory System Devices FDA panel has confirmed the tendency to higher mortality with paclitaxel-based devices and is expected to debate…
EuroCTO: Rechanneling vs. Optimal Medical Treatment in Total Occlusions
Courtesy of the SBHCI. Chronic total occlusions represent around 18% of all coronary lesions. However, they account for just 5% of all interventions, which means that many patients only receive medical treatment. This prospective, open, multicenter study randomized patients with multivessel lesions in whom at least one of these was a chronic total occlusion. Patients…
Missed Opportunities with Patients with Peripheral Vascular Disease
Little is known about how good are our counseling efforts on medication use and lifestyle as regards patients with peripheral vascular disease. More often than not, we use our time with these patients to discuss the technical feasibility of rechanneling, or to analyze the risk of eventual amputation. However, how often do we seize the…
Conservative Management of MI risk in ACS
Original Title: Spontaneous MI after Non–ST-Segment Elevation Acute Coronary Syndrome Managed without Revascularization. The TRILOGY ACS Trial. Reference: Renato D. Lopes et al. J Am Coll Cardiol. 2016;67(11):1289-1297. Patients admitted with acute coronary syndromes (ACS) and especially those managed conservatively without revascularization, are at high risk of a new spontaneous infarction. However, MI risk rate…
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