The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing myocardial revascularization surgery is unclear. What does seem somewhat certain is that some antiplatelet therapy is necessary to prevent early thrombosis, mainly in vein grafts, but (as opposed to what happens with angioplasty) there are other relevant factors such as…
FFR to Predict CABG Result: All Benefits in a Population Much Too Pure?
Coronary artery bypass graft (CABG) anastomosed to one vessel with normal or nearly normal fractional flow reserve (FFR) have poorer graft patency at one year compared against anastomosed grafts to vessels with functionally significant lesions shown by FFR. However, the recent study FARGO (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization) did not show…
Peri-Procedural Infarction in Angioplasty vs. Surgery in the Left Main Coronary Artery
According to the EXCEL trial, peri-procedural infarction was more common after left main coronary artery surgery compared with angioplasty, and it was strongly associated with increased 3-year mortality after controlling all possible confounding variables. This increased mortality was only present in extensive infarctions with an increase in CK-MB ≥10×. The EXCEL trial seems to want…
Surprising EXCEL Outcomes in Diabetics with Main Left Stenosis
This study especially designed to compare PCI vs. CABG in patients with left main coronary artery disease and low to intermediate Syntax score showed that 30-day and 3 -year outcomes of PCI with everolimus eluting stents vs CABG were consistent both in diabetic and non-diabetic patients. The randomized EXCEL trial (Evaluation of XIENCE versus Coronary…
Angiography Guided CABG Still Adequate
Fractional Flow reserve (FFR) guided myocardial revascularization surgery (CABG) has similar graft failure rate and clinical outcomes as angiography guided CABG. When planning PCI, the value of FFR for lesion assessment pose no questions, but we know little when it comes to CABG. Since the early start, back when Dr. Mason Sones performed catheterizations and…
Outcomes of MAIN-COMPARE: A 10-Year Follow-Up for a Historical Rivalry
Angioplasty and myocardial revascularization surgery have competed over the left main coronary artery for a long time. There may be many points of view involved in the interpretation of trial outcomes. While surgeons consider the left main coronary artery to be suitable for surgery (except when faced with surgical contraindications), interventional cardiologists see the left…
PCI Right After CABG: How Bad Can it Be?
In-hospital PCI right after CABG is extremely rare, but it does increase morbidity, mortality and costs significantly. It is still unclear what predictors can be modified to prevent these very early angiography and angioplasty procedures in patients that generally leave the OR with visible EKG changes. Graft failure, distal vascular bed quality, technical error or…
EXCEL Outcomes: PCI vs CABG in Patients with Prior Cerebrovascular disease
Most certainly, as we read this title, we imagine the conclusion (as does the editor): patients with prior cerebrovascular disease (CEVD) benefit from a less invasive revascularization strategy, such as PCI. However, the EXCEL outcomes tell us that patients with left main coronary artery disease (LMCAD) and a history of CEVD will not benefit from…
ACC 2019 | PARTNER 3: Low Risk TAVR vs. Surgery, Fewer Events per Year
Courtesy of Dr. Carlos Fava. TAVR has largely been shown superior or non-inferior in high or intermediate risk patients. Indeed, the development of new technologies, the more simplified procedure and the increased experience of operators and team have allowed these groups to benefit from this strategy. However, there is little evidence available on low risk…
ACC 2019 | TAVR in Low-Risk Patients Is Noninferior
Courtesy of Dr. Carlos Fava. Self-expanding supraannular aortic valves have proved to be superior to surgery in high-risk patients and noninferior in intermediate-risk patients. However, the current challenge is posed by low-risk, generally younger, patients. In that sense, our purpose is to determine device effectiveness and safety in terms of mortality and stroke rates (which are…