How to set up regional STEMI networks: a "Stent - Save a life!" initiative.

Clinical guidelines recommend the development of ST-elevation myocardial infarction (STEMI) networks at community, regional and/or national level to ideally offer primary coronary angioplasty, or at least the best available STEMI care to all patients. However, there is a discrepancy between this clinical recommendation and daily practice, with no coordinated care for STEMI patients in many regions of the world. While this can be a consequence of lack of resources, in reality it is more frequently a lack of organisational power. In this paper, the Stent - Save a Life! Initiative (www.stentsavealife.com) proposes a practical methodology to set up a STEMI network effectively in any region of the world with existing resources, and to develop the STEMI network continuously once it has been established.

TAVR prosthesis recoil: Unknowns and implications.

TAVR acute recoil has not been properly assessed with current generation balloon-expandable prosthesis. Acute recoil was greater during initial deployment than in postdilatation, in middle stent than inflow or outflow, and in antero-posterior than lateral axis. No predictors or clinical implications of acute valvular recoil were detected, calling for further research to better understand this phenomenon.

Retrograde approach for chronic total occlusion angioplasty: At your own risk.

The retrograde approach is needed to increase procedural success in chronic total occlusion angioplasty. This systematic review of the literature demonstrated that retrograde approach is associated with more complex anatomy, worse in-hospital and long-term outcomes. Retrograde approach needs expertise, used judiciously, and major focus in patient safety when performed.

Transradial access: A case for knowledge translation.

Current transradial access (TRA) practices are unknown in the United States and the rest of the world. There is a decline in preprocedure collateral assessment, low use of ultrasound, and infrequent radial patency check after hemostasis. Significant knowledge-practice gaps exist in TRA calling for more dissemination and education.

Transcatheter aortic valve replacement hemodynamic durability: Still in question?

This study shows excellent transcatheter aortic valve replacement hemodynamic mid-term durability, aligned with prior research up to 5-years. Long-term (10+ years) data are needed before treating young low-risk people with aortic stenosis. Data so far are excellent, indicating a prosperous future for this procedure in young patients.

Impella support for chronic total occlusions angioplasty: A good start.

There is limited data regarding percutaneous ventricular support in chronic total occlusion angioplasty in terms of population, procedure, and outcomes. This is the largest report to date showing promising results in terms of technical and procedural success in this highly comorbid population. This study encourages more research in the area and its use in large volume and experienced centers.

Anticoagulation with heparin The art of simplicity even in patients on dialysis.

In current PCI practice, anticoagulation with either bivalirudin or unfractionated heparin in patients with ACS share comparable efficacy and safety. Nonetheless, their individual performance in patients on dialysis remains unclear. This observational PCI study reported in-hospital clinical outcome in patients on dialysis undergoing PCI according to drug regimen: bivalirudin versus heparin. Similar clinical outcome was observed with both drug regimens.

Direct stenting versus balloon predilation: Jury is still out.

Compared to balloon predilation, direct stenting (DS) shortens procedural time and reduces radiation and contrast exposure. A meta-analysis that included 7 studies comparing these 2 strategies revealed lower adverse event rate with DS. Studies included in the present meta-analysis were mostly observational and utilized first generation drug-eluting stent. Patient and lesion selection may explain these positive results.

Percutaneous coronary interventions in diabetics: The never-ending challenge.

Diabetes mellitus (DM) is a multisystem disorder and a recognized risk factor for coronary artery disease (CAD) and DM patient are particularly challenging for revascularization. In this "real world" retrospective study post-PCI DM patients showed a high risk profile compared to the non-DM group, given by the higher prevalence of cardiovascular risk factors, multiple vessel disease, and renal dysfunction, with the highest rates seen in the ITDM. Only ITDM patients present higher 30-day mortality compared to non-DM patients in the urgent and primary PCI setting. Also ITDM, but not those NITDM patients, had an increased long-term mortality in the overall cohort and in all PCI setting.

Predicting Early Readmission Following PCI: A Work in Progress.

Early hospital readmissions after percutaneous coronary interventions (PCI) are common and costly. From the NCDR CathPCI Registry and the Centers for Medicare and Medicaid Services, a risk prediction model was generated using 14 clinical variables, demonstrating modest discrimination. Future research is needed to identify interventions aim to reduce early readmissions. The use of this risk model may help guide these interventions.

Overlapping bioresorbable scaffolds seems safe for now.

Overlapping permanent scaffolds carries a long-term risk of target vessel failure due to late malapposition and the development of neoatherosclerosis. Potentially, overlapping bioresorbable scaffold (BRS) may lead to lower long-term risk. The GHOST-EU registry reported similar short- and mid-term risks in patients with and without BRS overlap. Larger size studies with longer follow-up are needed to confirm the safety of BRS overlap.

Double-stenting in distal left main lesions: Let's crush.

Unprotected distal left main (ULM) lesions often require double-stenting. In the MITO Registry, a mini-crush stenting technique was safer than culotte stenting. Performing mini-crush arises as the best approach in patients with distal ULM lesions requiring elective double-stenting.