Myocardial revascularization surgery is still one of the most effective treatment strategies against coronary disease. One of the most important advantages of surgery over angioplasty is the chance to reach complete revascularization. This has proven to improve the survival of patients and to reduce the number of cardiovascular events. The choice of conduit for the…
Is Complete Revascularization the Right Choice in Acute Myocardial Infarction with Multivessel Disease?
Courtesy of Dr. Carlos Fava. Primary coronary angioplasty has been the treatment of choice for acute myocardial infarction (MI) for many years, but such strategy is associated with nonculprit lesions in a large group of patients. While it has been proven that nonculprit-lesion revascularization offers better outcomes, the groups that would benefit from it are…
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 | COMPLETE: Definitive Evidence for Infarction with Multivessel Disease
For patients with ST-segment elevation acute myocardial infarction and multivessel disease beyond the culprit artery, complete revascularization is superior to culprit-only treatment as regards the final endpoint, a composite of cardiovascular death, infarction, and ischemia-driven revascularization over a mean follow-up of 3 years. This information derives from long-awaited randomized study COMPLETE, finally presented at the…
Amount of Baseline Ischemia in Patients with Multivessel Disease and Long-Term Progress
According to this recent analysis of the MASS II trial, which will soon be published in JAMA, baseline ischemia is not associated with events at 10 years in patients with chronic stable angina. The ischemic burden induced through exercise does not predict events or long-term ventricular function. Such data add some suspense to the results…
What Happens When We Are Blinded by Left Main Disease and Ignore All Other Lesions?
According to this recent Excel analysis, mortality seems to rise when the SYNTAX II score is not taken into account when defining the revascularization strategy. The difference does not reach statistical significance and further studies are required, but the message is clear: the left main coronary artery is not the only thing that matters; other…
Staged Complete Revascularization vs. Culprit Vessel PCI at Long-Term
Staged complete revascularization in patients with acute myocardial infarction and multivessel coronary disease is superior to culprit PCI only at five-year follow-up. The outcomes of this retrospective analysis show the benefit of staged PCI, though it might be attenuated in diabetic patients. Outcomes are consistent with previously published randomized studies. Nevertheless, we should remain cautious…
Revascularization in Patients with Multivessel Disease, Diabetes, and Kidney Disease
According to this new study, in patients with coronary disease, diabetes, and chronic kidney disease who underwent revascularization through angioplasty or surgery, events are similar. This is one of the first studies painting the real picture for the prognosis of patients revascularized in these conditions (diabetes plus chronic kidney disease). At first sight, these…
Complete Revascularization Improves Long-Term Prognosis in Acute Coronary Syndromes
Going beyond the culprit artery during angioplasty was associated with lower mortality, although this was a cohort study that should be confirmed through randomized trials. According to this new observational study, patients experiencing non-ST-segment elevation myocardial infarction with multivessel disease seem to benefit from complete revascularization during initial angioplasty. This study, published online before…
Stroke Rate after CABG vs PCI in over 10,000 Patients
Repeat revascularization rate has historically been the weak spot of PCI when compared against CABG: we are still unable to compete with a well done internal mammary artery graft connected to the anterior descending artery. However, repeat revascularization is the soft of end points commonly assessed in trials, and even though several studies have shown…