Roxana Mehran

Shamir Mehta

Interventional cardiologist, McMaster University/PHRI · McMaster University/Population Health Research Institute

2w

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The most important goal of primary PCI is to open the infarct-related artery and establish perfusion to the ischemic myocardium. It's not to open the nonculprit artery. We know that primary PCI is a lifesaving procedure and that should be the focus.

Gennaro Giustino

Cardiology Fellow, Mount Sinai Hospital · Icahn School of Medicine at Mount Sinai

2w

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Understanding the substrate gives you information on whether you need further diagnostic workup or if you need to adopt specific treatments. If you have wall motion abnormalities, that can be secondary to thrombosis in the epicardial coronary arteries or in the microcirculation. If you have global dysfunction, that would be, perhaps, myocarditis. If you have right ventricular dysfunction, that can be very bad respiratory failure or pulmonary embolism. All that starts to give you some sense of what is happening pathophysiologically to a patient.

Roxana Mehran

Interventional cardiovascular research director, Mount Sinai · Mount Sinai

3w

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Dr. Mensah et al. provided an essential pre-pandemic map of cardiovascular disparities across time, place, race and ethnicity. The next challenge is to turn this map into a roadmap for action. Our commitment to cardiovascular health equity should be measured not by how precisely we describe inequities, but by how effectively we close them.

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Brain imaging changes being reported do not necessarily translate into clinical strokes, but many of us worry that with every loss of brain cells, some subclinical degradation of cognitive, behavior, motor, or other important brain functions occurs.

Wayne Batchelor

Interventional cardiologist, Inova Heart & Vascular Institute · Inova Heart & Vascular Institute

5w

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Underserved populations have all sorts of characteristics. We tend to focus on race, sex, and ethnicity, but the elderly can be underserved and rural Americans who live from far distances from TAVR centers and centers of expertise can have access issues.

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The current analysis of the AUGUSTUS trial overcomes these disadvantages of meta-analyses and includes the added dimension of triple therapy with aspirin and a P2Y12 inhibitor plus either apixaban or a VKA. It demonstrated that dual therapy is superior to triple therapy for the combined primary endpoint, which included ischemic and bleeding events, and that apixaban is superior to VKA for dual therapy with a P2Y12 inhibitor.

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It's another signal confirming that there are reasonable concerns about bioresorbable vascular scaffolds. We're seeing [adverse events] in multiple databases fairly consistently. This is coming in at the end after it's already being pulled off the market, so the clinical implications are somewhat limited at this point. Nevertheless, it really highlights the need for surveillance of new devices.