Guidelines recommend delaying elective surgery in patients with drug eluting stent (DES) for one year after stent implantation to allow completion of 1 year of dual anti-platelet therapy (DAPT) without interruption. This recommendation is based on expert consensus and results in several clinical questions, including whether it is preferable to use a bare metal stent […]
Category: Interventional cardiology
No clinical outcome benefit from IABP support
The IABP-SHOCK II trial is the largest randomized trial of intra-aortic balloon pump (IABP) counterpulation support in cardiogenic shock. At 30-days follow-up, this trial demonstrated no mortality reduction. The current paper reports the longer term outcomes from this trial, given that the benefits of IABP may not be evident in early follow-up. […]
Thrombus aspiration in STEMI fails to demonstrate benefit
Thrombus aspiration during primary PCI for patients presenting with ST elevation myocardial infarction (STEMI) is an intuitively attractive manoeuvre to aid rapid reperfusion, reduce distal embolization and improve microvascular perfusion. Despite limited trial evidence of clinical benefit, the procedure has quickly taken hold in many PCI centres with European and US guidelines agreeing on a […]
Bivalirudin in contemporary STEMI treatment
The novel direct thrombin inhibitor bivalirudin is now widely used as an adjunctive therapy in patients undergoing primary PCI for ST elevation myocardial infarction (STEMI). This stems from trial data demonstrating bivalirudin results in lower bleeding rates and better long term survival as compared with the combination of heparin and a GP IIb/IIIa inhibitor. However, […]
Smoking and antiplatelet agents – smoke and mirrors or something more?
Many antiplatelet therapies are prodrugs that require metabolic activation. It has been hypothesized that smoking may activate this metabolic conversion for some antiplatelets (i.e. clopidogrel) more than others (i.e. prasugrel and ticagrelor). In this systematic review and meta-analysis, the authors identified 9 randomized controlled trials of clopidogrel, prasugrel, or ticagrelor which examined outcomes among subgroups […]
Treatment of bystander coronary disease in primary PCI improves outcomes
In patients with ST-elevation myocardial infarction (STEMI), current guidelines support PCI of the infarct related artery and medical management of flow-limiting lesions in non-infarct related vessels (so-called bystander disease). This paradigm is challenged in the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study. In this single-blind trial performed at five UK centres, patients presenting with […]
Bilateral internal mammary grafts in diabetics: benefits outweigh perioperative risks
Patients with diabetes have more severe coronary disease at presentation and worse overall outcomes than their non-diabetic counterparts, even following surgical revascularisation. Whilst use of the left internal thoracic artery (LITA) is well established and improves event free survival when anastomosed to the LAD, the use of both right and left internal thoracic arteries in […]
Triple therapy post-PCI? WOEST clarifies
20-30% of patients taking oral anticoagulants also have ischaemic heart disease that requires treatment by percutaneous coronary intervention (PCI), thereby necessitating dual anti-platelet therapy to prevent stent thrombosis. However, the combination of dual anti-platelet therapy (DAP) and anti-coagulants is associated with a high annual risk of fatal and non-fatal bleeding episodes. This study hypothesised that […]
PCI: Bleeding events correlate with early mortality
Although bleeding following percutaneous coronary intervention (PCI) has previously been linked with short- and long-term mortality, this association was derived from highly selected randomised controlled trials. This large study used the CathPCI registry to estimate the adjusted population attributable risk of bleeding-related mortality in patients undergoing PCI in the United States. […]
SYNTAX II: Improved predictive value
The anatomical SYNTAX score is advocated in both US and European guidelines to help establish the best revascularisation approach in patients with complex coronary artery disease. The purpose of this study was to improve the SYNTAX score further by including prognostically important clinical variables, as opposed to the anatomical variables that are used for the […]