Major advances have been made in primary reperfusion and adjunctive therapies for STEMI. Mechanical reperfusion therapy has become the preferred reperfusion strategy for patients with STEMI. Outcomes have improved with the use of stents, platelet inhibitors, and with increased experience, and there is a promise that outcomes can become even better with new methods to enhance myocardial reperfusion and reduce reperfusion injury and with new anticoagulants and drug-eluting stents. Recent trends from the NRMI have shown that the frequency of use of primary PCI has increased and has surpassed lytic therapy, but primary PCI is used to treat only a minority of patients with STEMI. The major challenge for clinicians in the next decade will be to find new ways to make mechanical reperfusion more available, improve outcomes through the use of optimal adjuvant therapies and improved systems of care to speed primary PCI. The nation-wide effort to reduce door-to-balloon times has been launched by American Heart Association, with goal of making primary PCI more available to patients with STEMI.
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EuroIntervention
January 2025
Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain and Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Background: Safe deferral of revascularisation is a key aspect of physiology-guided percutaneous coronary intervention (PCI). While recent evidence gathered in the FAVOR III Europe trial showed that quantitative flow ratio (QFR) guidance did not meet non-inferiority to fractional flow reserve (FFR) guidance, it remains unknown if QFR might have a specific value in revascularisation deferral.
Aims: We aimed to evaluate the safety of coronary revascularisation deferral based on QFR as compared with FFR.
Int J Cardiol
December 2024
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute of Wuhan University, Wuhan, China; Hubei Key Laboratory of Cardiology, Wuhan, China. Electronic address:
Aims: Timely assessment of abnormal microvascular perfusion (MVP) may improve prognosis in patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical implications of contrast-flow quantitative flow ratio (cQFR) in evaluating abnormal MVP and subsequent outcomes among STEMI patients after successful primary percutaneous coronary intervention (PPCI).
Methods: The study population consisted of 2 independent cohorts.
J Invasive Cardiol
December 2024
Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
Objectives: A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast. The authors evaluated how the contrast shortage impacted percutaneous coronary interventions (PCI).
Methods: Using a statewide database incorporating CathPCI registry data from 19 hospitals, the authors evaluated 2 time periods: pre-shortage (May 1, 2021 - April 30, 2022) and during the shortage (May 1, 2022 - October 31, 2022).
J Invasive Cardiol
December 2024
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Objectives: Antegrade wiring (AW) is the most common coronary chronic total occlusion (CTO) crossing strategy and usually relies upon stepwise guidewire escalation starting from the low tip-load polymer-jacketed wire (standard guidewire escalation). The authors aimed to investigate whether the upfront use of intermediate tip-load polymer-jacketed guidewire translates into improved procedural outcomes of CTO percutaneous coronary intervention (PCI).
Methods: The Gladius First trial was a single-center, investigator-initiated, randomized, prospective trial.
Ther Adv Cardiovasc Dis
January 2025
Section of Cardiology, Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, MB, Canada Y3006 - 409, Tache Avenue, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada.
Background: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, the impact of revascularization in this patient group is relatively unknown.
Objectives: The purpose of our study was to evaluate the efficacy of percutaneous coronary intervention (PCI) in patients with previous CABG surgery presenting with ACS.
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