1,721,104 research outputs found
SENIOR-RITA - Is It All about Angiography?
No full textEditorial on SENIOR-RITA trial published on NEJ
Complete or Culprit-Only PCI in Older Patients with MI. Reply
No full textTo the Editor: In their article on the FIRE trial, Biscaglia et al. (Sept. 7 issue)(1) state that the use of physiology-guided complete revascularization resulted in a lower risk of death from cardiovascular or other causes than percutaneous coronary intervention (PCI) alone in older patients (age, >= 75 years) with myocardial infarction and multivessel disease. This reduction in overall mortality was unexpected because such a benefit has not been reported in previous randomized, controlled trials comparing invasive strategies with conservative strategies among older patients with non-ST-segment elevation myocardial infarction (NSTEMI) or comparing complete versus culprit-only revascularization among patients with ST-segment elevation . .
Does the Timing Matter in Invasive Management of Non-ST-Segment-Elevation Acute Coronary Syndrome?
No full textEditorial on invasive management of female NSTEMI patient
Meta-Analyses on DAPT Length
No full textIn the last 2 years clinicians were all caught in the middle of a perfect storm of meta-analyses regarding dual antiplatelet therapy (DAPT). Recently, Palmerini et al. reaffirmed the link between bleeding, all cause mortality, and DAPT duration after drug eluting stent implantation. The storm started with a meta-analysis by the same author showing a mortality increase in patients treated with longer DAPT regimen. Two worthy studies seemed to brighten up the sky for clinicians. Yeh et al. suggested that the myocardial infarction (MI) asclinical presentation could be the discriminating factor in DAPT decision-making. Patients presenting with MI showed a benefit from longer DAPT in terms of recurrence of MI, without any increase in mortality. Similarly, the collaborative metaanalysis of randomized trials on patients with MI by Udell et al. confirmed the paramount importance of clinical presentation, showing a cardiovascular mortality reduction without increase of noncardiovascular mortality and fatal bleedings in patients treated with longer DAPT regimen. Then, clinicians are likely to refall into confusion reading the present meta-analysis in which post-MI patients are only 14%. As a matter of fact, the same metaanalysis starting the storm included a small portion of prior-MI (19%) and index-MI (25%) patients. We think that, to reach the “calm after the storm,” clinicians should stop stressing old studies with old P2Y12 inhibitors on stable patients and address the real unmet clinical need in everyday clinical
practice, namely the recurrence of ischemic adverse events in post-MI patients
Fractional flow reserve: Current applications and overview of the available data
No full textFlow fractional reserve (FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure during maximum hyperemia. The actual widely accepted cut-off value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1 (FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points (death, myocardial infarction, and urgent revascularization). Consequently, FFR evaluation represents the cornerstone in the decision-making in intermediate coronary lesions. Recent studies paved the way for further applications of FFR evaluation in complex and tricky clinical settings. In this paper, we perform an overview of the data regarding contemporary application of FFR. In particular, we review the use of FFR in: left main intermediate stenoses, serial stenoses, evaluation after stenting, guidance in coronary artery bypass surgery, and acute coronary syndrome. All the data presented in our overview confirm the essential role of FFR assessment in the daily clinical practice. The shift from "operator-dependent" to "FFR-dependent" evaluation in intermediate coronary artery stenosis is of paramount importance in order to improve the prognosis of our patients, through the discrimination of the functional role of every single coronary stenosis
Perfect Wedding Between Patient With STEMI and Angiography-Derived Indexes of Coronary Physiology
No full textWire-based coronary physiology is the current gold standard for the assessment of both epicardial and microvascular coronary functio
Functional Assessment and Acute Coronary Syndrome
No full textFunctional Assessment and Acute Coronary Syndrom
Frailty in an Elderly Cohort With Myocardial Infarction and High Bleeding Risk-Reply
No full textthe FIRE trial and the present HBR subanalysis demonstrated the benefit of physiology-guided complete revascularization on hard outcome at 1-year follow-u
Bioresorbable Everolimus-Eluting Vascular Scaffold for Long Coronary Lesions
No full textcomment about scaffold performance on very long coronary lesion
Does morphine attenuate the Inhibition of Platelet Aggregation for both oral and parenteral P2Y12 inhibitors?
No full textThis is a post-hoc analysis from the FABOLUS FASTER trial (NCT 02978040) which randomized 122 P2Y12-inhibitor naïve STEMI patients undergoing primary PCI to cangrelor (n = 40), tirofiban (n = 40), or 60-mg loading dose of prasugrel either chewed or integral (n = 42) [2]. All patients received aspirin before PCI
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