Historically, we have believed that mental stress might induce chest pain as a response to increased levels of catecholamines and consequently increased product (by 100%), just as it happens with physical stress. This innovative study published in Circ Cardiovasc Imaging shows the activation of specific areas in the brain is independently associated with chest pain…
TCT 2020 | Fewer Symptoms and Events when Optimizing with iFR
Symptomatic patients undergoing PCI with no residual ischemia confirmed by iFR have superior symptom improvement at one year vs. patients who did not receive the optimization. In addition to symptoms, patients receiving iFR optimization (final value ≥ 0.95) presented lower cardiac mortality, spontaneous MI or clinically justified revascularization vs. patients with <0.95 final value. …
Chronic Coronary Syndromes Nowadays
Multiple drugs and treatment strategies have emerged in recent years to change significantly the prognosis of patients who suffer from stable chronic angina or, in terms of the latest guidelines, “chronic coronary syndromes.” This semantic change may seem of little importance, but it is intended to remind us that these are not stable patients, 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%…
AHA 2019 | ISCHEMIA: The Invasive Approach (PCI or Surgery) Results Similar to Optimal Medical Treatment
After a several year follow up, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) has shown that an invasive approach in addition to optimal medical treatment (OMT) does not offer benefits when it comes to preventing major cardiovascular events compared against optimal medical treatment alone in stable patients with moderate…
Predicting Coronary Angioplasty Benefits
Coronary angioplasty or percutaneous coronary intervention (PCI) reduces angina and improves quality of life in patients with stable ischemic cardiomyopathy, though the ORBITA study has shed new light on this. Meanwhile, we will assume this is indeed the case, until new studies either confirm or refute the above mentioned, controversial study. Either way, it is…
Clinical Utility of CT-Derived FFR for Decision-Making
In this large international multicenter population, computed-tomography (CT)-derived fractional flow reserve (FFR) modified treatment recommendation in two-thirds of subjects compared with CT angiography alone, and it was associated with less negative invasive angiographies. It also predicted revascularization and identified low-risk patients. A non-invasive means to know the anatomy and function of patients with stable chronic…
An Effort Worth Your While: Rechanneling vs. Optimal Medical Treatment in Total Occlusions
Successful rechanneling of a chronic total occlusion (currently around 90%) leads to significant improvement in quality of life and symptom frequency in patients with stable chronic angina compared with optimal medical treatment alone. These results are promising and what we ultimately expected, although symptoms, as a primary endpoint in themselves, are in the eye of…
ESC 2018 | CLARIFY: No Survival Benefit with Beta-Blockers Beyond 1 Year After Infarction
This is another study that concludes that beta-blockers have no impact on mortality at 1 year after infarction in stable patients and offer no survival benefit to patients with stable ischemic heart disease who have not experienced a myocardial infarction. This analysis represents 5 years of follow-up in a large, multinational registry and also shows a lack…
Patients and Healthcare Providers Benefit from Less Symptoms and Lower Costs with FFR
Previous studies in which revascularization was guided by angiography alone found that coronary angioplasty does not improve outcomes compared with optimal medical treatment in patients with chronic stable angina. The FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared angioplasty guided by fractional flow reserve (FFR) with optimal medical treatment, arriving to…
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