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  • In a nutshell: The...

In a nutshell: The hottest developments in the field of cardiology in 2020. Section 5. Coronary artery disease - Page 5

Written By : dr. Abhimanyu Uppal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-12-31T11:00:04+05:30  |  Updated On 31 Dec 2020 12:55 PM IST
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9. DEFINITION II (Two-Stent vs. Provisional Stenting Techniques for Patients With Complex Coronary Bifurcation Lesions) Trial

Two-stent strategy was superior to provisional stenting for complex bifurcation lesions.

Patients undergoing revascularization of a complex bifurcation lesion (defined as side branch lesion length ≥10 mm, and side branch diameter stenosis ≥70% for distal left main lesions or ≥90% for non-left main lesions) were randomized to a two-stent versus provisional stenting strategy. In the two-stent strategy, the DK-crush (or culotte technique) was strongly encouraged.

Among patients with a complex bifurcation lesion undergoing revascularization, a two-stent strategy was superior to provisional stenting.

The two-stent strategy was associated with a reduction in target lesion failure at 12 months. Benefit was due to reductions in target vessel myocardial infarction and target lesion revascularization. There was a numerical reduction in definite/probable stent thrombosis with the two-stent vs. provisional strategy.

Prior to the introduction of the DK-crush technique, a two-stent strategy was associated with inferior outcomes compared with provisional stenting. Accumulating data support DK-crush as the preferred technique for revascularization of complex bifurcation lesions. For simple bifurcation lesions, provisional stenting may still be considered.

Source: European Heart Journal: Zhang JJ, Ye F, Xu K, et al. The DEFINITION II trial. Eur Heart J 2020;Jun 26


10. Compare-Acute (Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction) trial

FFR-guided complete revascularization during the index procedure was superior to infarct artery only revascularization.

STEMI patients undergoing primary PCI were randomized to FFR-guided complete revascularization (n = 295) versus infarct artery only revascularization (n = 590). All patients underwent FFR of nonculprit stenoses ≥50%.

The primary outcome, incidence of all-cause death, MI, cerebrovascular event, or any revascularization at 12 months, occurred in 7.8% of the complete group versus 20.5% of the infarct artery only group (p < 0.001).

There was no difference in mortality or MI. Benefit for complete revascularization was driven by a lower rate of future revascularization procedures. Adverse events among non-revascularized lesions tended to occur with FFR values <0.8.

Complete revascularization during the index procedure, which was mostly conducted in this trial, is the most efficient strategy and eliminates the need for future catheterization procedures.

Source: JACC Interventions. Piróth Z, Boxma-de Klerk BM, Omerovic E, et al. The Natural History of Nonculprit Lesions in STEMI: An FFR Substudy of the Compare-Acute Trial. JACC Cardiovasc Interv 2020;13:954-61.

11. ON-TIME 3 (Impact of opioids on P2Y12 receptor inhibition in patients with ST-elevation myocardial infarction who are pre-treated with crushed ticagrelor: Opioids aNd crushed Ticagrelor In Myocardial infarction Evaluation) Trial

Acetaminophen in patients with ST-elevation MI (STEMI) provides pain relief comparable to fentanyl comparable pain relief but with desirably higher blood levels of ticagrelor both immediately after primary percutaneous intervention and 1-hour post procedure.

The synthetic opioid fentanyl impairs gastrointestinal absorption of oral P2Y12 receptor antagonists such as ticagrelor. Opiates do so as well, whereas acetaminophen does not.

ON-TIME 3 was a multicenter, open-label, phase 4 clinical trial in which 195 STEMI patients with a self-reported pain score of at least 4 on a 0-10 scale received crushed ticagrelor in the ambulance along with either 1,000 mg of IV acetaminophen or fentanyl at 1-2 mcg/kg.

Ticagrelor blood levels were significantly higher in the IV acetaminophen group when measured just prior to primary PCI (151 ng/mL versus 60 ng/mL in the IV fentanyl group; immediately after PCI (326 versus 115 ng/mL), and 1-hour post PCI (488 versus 372 ng/mL).

Source: European Heart Journal: https://doi.org/10.1093/ehjcvp/pvaa095


latest cardiology developmentslatest cardiology trialsCoronary artery diseaseantiplateletsLeft main coronary artery diseasebifurcation lesions
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dr. Abhimanyu Uppal
dr. Abhimanyu Uppal

    MBBS, MD , DM Cardiology

    Dr Abhimanyu Uppal completed his M. B. B. S and M. D. in internal medicine from the SMS Medical College in Jaipur. He got selected for D. M. Cardiology course in the prestigious G. B. Pant Institute, New Delhi in 2017. After completing his D. M. Degree he continues to work as Post DM senior resident in G. B. pant hospital. He is actively involved in various research activities of the department and has assisted and performed a multitude of cardiac procedures under the guidance of esteemed faculty of this Institute. He can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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