Multivessel disease associated to ventricular function deterioration is challenging in terms of risk, when choosing a revascularization strategy. According to this recent analysis of the SCAAR registry published in the European Heart Journal, long term followup seems to justify taking a higher risk initially, higher risk being myocardial revascularization surgery (CABG). The study looked at…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…
ACC 2021 | Emergent CABG for acute MI: Benefits Despite Risk
The latest figures show a lower number of emergency CABG for acute MI, and in turn increased primary PCI. The combination of surgeons not willing to take risks and interventional cardiologists empowered to treat practically any lesion has resulted in fewer patients receiving emergency CABG. Only a few years ago, interventional cardiologists at least had…
FREEDOM with FFR: Different Outcomes?
The FREEDOM has clearly established the benefit of myocardial revascularization surgery (CABG) over percutaneous coronary intervention (PCI) in diabetic patients with multivessel disease. Coronary physiology as guideline for revascularization works best precisely in this kind of patients and its impact has never been studied in diabetics. This study, published in Circ Cardiovasc Interv, assessed the…
AHA 2020 | Effect of Evolocumab in Complex Coronary Revascularization
Evolocumab, a PCSK9 inhibitor, has shown significant reduction of complex coronary disease requiring revascularization (be it PCI or CABG). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and could eventually reduce the risk of coronary revascularization, especially complex revascularization. The FOURIER study randomized 27564 patients with stable CAD already on statins to evolocumab…
Ticagrelor to Improve Venous Graft Patency
Saphenous vein graft patency is one of CABG’s “Achilles heals”, especially after the ARTS trial came out showing bilateral internal mammary artery grafting was not superior to simple internal mammary artery grafting. Antiaggregation more potent than aspirin might prolong venous graft patency in cases when the available techniques will fail to improve poor outcomes. Previous…
ESC 2020 | At Long Term, Diabetic Patients Benefit from Surgery
Data of this “real world” study have confirmed that diabetic patients with multivessel disease will benefit from coronary artery bypass grafting (CABG). According to Dr. Douglas S. Lee, main author of this study, the evidence is fairly conclusive, enough to recommend CABG as first option in this particular subgroup of patients similar to FREEDOM patients. …
More Data from the EXCEL and More Controversy
A thorough statistical analysis of the EXCEL has quite definitely shown that the likelihood of death, MI or stoke, including total mortality, is higher with PCI compared against CABG. The Bayesian analysis estimated a 3.3% difference in mortality, superior in the PCI arm, with 99% probability that EXCEL total mortality was indeed increased with PCI…
Should We Finalize TAVR with Atrial Pacing in Some Patients?
Courtesy of Dr. Carlos Fava. The benefits of transcatheter aortic valve replacement (TAVR) are undoubtedly clear, but implantation is performed near the atrioventricular (AV) node, the bundle of His, and the left bundle branch. Consequently, permanent pacemaker implantation (PPI) after TAVR or surgical aortic valve replacement becomes necessary. While researchers have recently developed strategies to reduce…
Virtual ACC 2020 | PRECOMBAT: 10 Years for Surgery vs. Angioplasty in Left Main Coronary Artery Disease
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few…