Angioplasty could not reach non-inferiority to surgery to treat patients with three-vessel lesions. In this head-to-head study of both revascularization strategies in patients with three-vessel coronary disease, fractional flow reserve (FFR)-guided angioplasty could not reach the performance of myocardial revascularization surgery in relation to a composite of adverse events. The FAME 3 study was presented during…
Complex PCI: Complex Characteristics Impact Results
Patients with a bigger number of complex anatomical characteristics that increase PCI complexity have worse results at one-year followup. These data come from a large multicenter study (e-Ultimaster) recently published in EuroIntervention. The more complex the characteristics, the greater the increase in events. It is important to see past the obvious anatomical challenges (bifurcations, calcification,…
Visual Assessment for Non-Culprit Lesion Revascularization
There is evidence in favor of complete revascularization in the context of ST elevation MI with multivessel disease where primary PCI has been successful. However, the small print in these studies should be read carefully. Should revascularization be completed during index intervention, index hospitalization or after discharge? Should complete revascularization be based on visual assessment,…
Long Term Changes ACS Revascularization
Long term outcomes support complete revascularization in multivessel patients undergoing acute coronary syndrome (ACS). This large contemporary registry recently published in J Am Coll Cardiol Intv. has shown complete revascularization is gaining ground in the daily practice and is associated to clinical benefits in patients undergoing ACS. It included 9094 individuals with ACS and multivessel…
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,…
ESC 2018 | CULPRIT-SHOCK: 1-Year Results Continue to Support Treatment of the Culprit Artery Only
Increases in the rates of revascularization and heart failure do not justify the early mortality advantage shown by treatment of the culprit artery only in patients with acute myocardial infarction and cardiogenic shock. The 1-year follow-up of the CULPRIT-SHOCK trial reinforces the idea of only treating the culprit artery, with an option for revascularization of…
ESC 2018 | FUTURE: A Thorn in FFR and More Questions than Answers
As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of…
EuroPCR 2018 | SYNTAX II: Results at 2 Years for Best Angioplasty vs. Surgery in Multivessel Disease
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of…
Does a Combination of Diabetes and Acute Coronary Syndrome Change the Revascularization Strategy?
The results of the FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial have shown a lower rate of events in patients with diabetes and stable multivessel disease who were randomized to undergo myocardial revascularization surgery, compared to those who underwent angioplasty. Surgery even showed a mortality reduction that…
Bilateral Mammary Artery Graft to Reduce the Chance of Repeat Revascularization
According to previous studies, patients receiving bilateral internal mammary artery conduits during coronary artery bypass grafting have better survival than those receiving a single internal mammary artery. The reason behind this remains unclear, let alone whether there really is lower repeat revascularization rate. This analysis compared timing, frequency, and type of repeat coronary revascularization among patients…
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