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Current Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Intervention
AbstractPurpose of ReviewTo review the clinical evidence on the use of percutaneous coronary intervention (PCI) revascularization options in left main (LM) disease in comparison with coronary artery bypass graft (CABG). Coronary artery disease (CAD) involving the LM is associated with high morbidity and mortality. Though CABG remains the gold standard for complex CAD involving the LM artery, recent trials have shown a trend towards non-inferiority of the LM PCI when compared with CABG in certain subset of patients.Recent FindingsTwo recent major randomized trials compared the outcomes of PCI versus CABG in the LM and multi...
Source: Current Cardiology Reports - February 7, 2020 Category: Cardiology Source Type: research

Advances in Antiplatelet and Anticoagulant Therapies for NSTE-ACS
AbstractThe treatment of patients requiring anticoagulation who develop acute coronary syndrome (ACS) and/or require percutaneous coronary intervention (PCI) must balance the reduction in major adverse cardiovascular events, stroke, and major bleeding. The development of direct oral anticoagulants (DOACs) for the treatment of atrial fibrillation has ushered in an era of potential treatment options for these complex patients.Purpose of ReviewTo review the clinical evidence underlying the use of DOACs for the treatment of patients with atrial fibrillation and ACS or PCI.Recent FindingsThree trials studied this particular pat...
Source: Current Cardiology Reports - January 12, 2019 Category: Cardiology Source Type: research

Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic Patients: Choosing Wisely Between PCI and Surgery
AbstractPurpose of ReviewPatients with type 2 diabetes mellitus (T2DM) are at an increased risk of systemic atherosclerosis and advanced coronary artery disease (CAD). Herein, we review clinical trials comparing surgical to percutaneous revascularization in the context of the unique pathophysiology in this patient population, and seek to answer the question of optimal strategy of revascularization.Recent FindingsEarly studies showed a signal towards benefit of surgical revascularization over percutaneous revascularization in this group, but there was a paucity of randomized clinical trials (RCT) to directly support this fi...
Source: Current Cardiology Reports - April 3, 2017 Category: Cardiology Source Type: research

The Role of Manual Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI
Abstract In STEMI, primary PCI restores macrovascular coronary blood flow effectively but microvascular perfusion remains a challenge. Thrombus has the potential to embolize to the microvasculature limiting effective coronary blood flow. Thrombus burden is associated with a higher mortality and manual aspiration thrombectomy has the potential to reduce thrombus burden. The first large trial of routine aspiration thrombectomy (TAPAS, N = 1071) showed an improvement in myocardial blush and an unexpected reduction in mortality. Reinforcing the enthusiasm for this finding meta-analysis of small trials also showed...
Source: Current Cardiology Reports - February 18, 2016 Category: Cardiology Source Type: research

Stenting Versus Surgery for Significant Left Main Disease
Abstract For decades, coronary artery bypass grafting (CABG) has been the choice of revascularization strategy for significant left main coronary artery (LMCA) disease. However, with marked technological advances in less invasive percutaneous strategies, such as drug-eluting stents, and potent adjunctive pharmacology, percutaneous coronary intervention (PCI) has been increasingly accepted as an alternative to CABG for selected cases with LMCA disease. The available evidence from randomized clinical trials and adequately sized, real-world registries suggest that hard clinical endpoints (death, myocardial infarctio...
Source: Current Cardiology Reports - February 22, 2015 Category: Cardiology Source Type: research