Davide Capodanno
@DFCapodanno
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Professor of Cardiology at University of Catania, Italy. Editor-in-Chief of @EuroInterventio .
Catania, Sicily
Joined March 2019
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Facts:
1) The CHA2DS2VASc score is not used to find patients who need anticoagulation, but those at low risk who do not.
2) The HAS-BLED score is not used to find patients at risk with anticoagulation, but to correct modifiable risk factors and "flag-up" for regular follow-up.
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Five points I remember after a first reading of the
@escardio
NSTEACS guidelines, which may impact our practice:
1) Bye bye CK-MB
2) Do not pretreat with P2Y12i (including ticagrelor)
3) Prefer prasugrel in PCI
4) Very short TAT in AF
5) Angio in NSTEMI within 24 h
#ESCCongress
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With the evidence generated so far, we may safely conclude that PCI does not improve survival in patients with SIHD. PCI remains key in ACS, and for the improvement of PROMs in consideration of patient compliance and wishes in relation to the intensity of anti-anginals.
#TCT2022
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Three notable class 3 recommendations against routine periodic testing in asymptomatic CCD patients from AHA/ACC guidelines:
1) no benefit with coronary CTA or stress testing
2) no benefit of periodic assessment of LVEF
3) harm with coronary angiography
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So, to recap: first I ask him about symptoms. If he is asymptomatic, I leave him alone. If he has symptoms, I ask a CCTA. If he has CAD on CCTA but not of the left main, then I explain the pros and cons of the invasive strategy. Finally I give him some colchicine.
#AHA19
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Transcatheter mitral valve replacement (TMVR) devices that are currently undergoing clinical testing have a high anatomical screen failure rate due to challenges with annulus size or left ventricular outflow tract obstruction.
The Saturn valve (InnovHeart) is a novel TMVR…
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About aspirin for primary cardiovascular prevention.
(I like this quote: "The best strategy for the use of aspirin in primary prevention may simply be to prescribe a statin instead." P. Ridker, NEJM 2018)
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This state-of-the-art review reports a detailed overview of the history, indications and treatment strategies for recanalization of chronic total occlusions.
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How a crazy idea led to a clinical revolution.
"To all those who believe that we as cardiologists can make a difference in our commitment to ideas, TAVI stands as an example of what such an idea can produce."
Rest in peace, Professor Cribier.
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Cardiology: not necessarily the best and most interesting branch of medicine, but I study it because it is congenial to me and it is my job. Having said that, I think I have had enough of reading about poor studies of COVID19 drugs. When do we go back to talking about cardiology?
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Trials comparing P2Y12 inhibitors. Prasugrel and ticagrelor are first-line therapies for patients with ACS; prasugrel should be preferred to ticagrelor in patients undergoing PCI. Clopidogrel is an alternative for patients at high risk of bleeding. SWITCH trial ongoing.
#TCT2022
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Spontaneous coronary dissections (SCAD):
1) are relatively uncommon, but represent one third of ACS causes in young women
2) are usually diagnosed by coronary angiography
3) heal spontaneously in the vast majority of patients
4) require CABG or PCI in selected cases
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Because viability was a prerequisite, the neutral results of PCI in the REVIVED trial challenge the concept of myocardial hibernation, which for decades has been considered an adaptation of the heart that can be reversed by revascularization.
#ESCCongress
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Two systematic reviews and meta-analyses of 300,000+ patients from 60+ trials informed the new EAPCI/ACVC/EAPC consensus document on antithrombotic treatment strategies for secondary or tertiary prevention in patients with established coronary artery disease.
#ESCCongress
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In this propensity-matched study of patients undergoing transfemoral TAVI, the upfront use of a collagen-based plug system on top of a suture-based closure device reduced the risk of major vascular complications and major or life-threatening bleeding.
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Coinciding with the beginning of
#EuroPCR
, the 16th Expert Consensus Document of the European Bifurcation Club is online ahead of print with two publications: Part 1 on the provisional pathway and Part 2 on two-stent strategies.
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Introducing "ShortCut", a novel device designed to split the leaflets of a degenerated bioprosthetic aortic valve in patients undergoing valve-in-valve TAVI procedures who are at risk for TAVI-induced coronary artery obstruction.
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The 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure are out, with new or revised recommendations, a different term for HFmrEF, a simpler algorithm for HFrEF, and a modified classification of acute HF.
#ESCCongress
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2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. A document of 156 pages, 26 tables and 20 figures. Two figures will probably attract more attention than others.
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Since its introduction almost two decades ago, the crush technique for coronary bifurcation stenting has undergone a significant and constant evolution. This paper reviews the technical aspects and outcomes of the variants of the crush technique.
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I'm glad to announce the new impact factor of EuroIntervention: 7.728.
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Today in class I explained the Takotsubo syndrome. Few things catch the listener's attention like the story of the octopus fishing basket. Once again it was the moment of greatest interest and curiosity of students in my course. Thank you inventor of the name Takotsubo.
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TAVI is twenty years old: performed, investigated, debated, with several questions looking for an answer. However, twenty years is a quite remarkable milestone, and the progress of other valve interventional procedures is far behind. A summary of the trials to date.
#ESCCongress
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Radial dilatation achieved by 10-minute inflation of a blood pressure cuff on the arm, followed by deflation prior to arterial puncture, results in fewer cannulation failures, puncture attempts and radial pulsation loss compared with a sham procedure.
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When lockdown is heavy to bear (and how heavy it is), it is useful to motivate ourself thinking that it is a long process but it works: today in Lombardy "only" +2% of new infected, +1% of new hospitalizations, +6% of deaths and for the first time a decrease of ICUs patients.
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In STEMI, the ability of intracoronary imaging to differentiate between plaque rupture and nonrupture is potentially helpful in decision-making for subsequent treatment strategies, including avoidance of stenting. Our editorial to the EROSION III trial.
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Hello from
#10daysahead
. Nobody sings victory, but finally a ray of sunshine, in the midst of this nightmare. Today:
- lowest daily variation since Feb 26: +10.4%
- in Lombardy, the region where the lockdown started earlier: +6.6%
- almost 1,000 recovered for two days in a row.
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If PCI as a "therapy" for stable ischemic heart disease is controversial, its role as a "prevention" for vulnerable plaques is even more controversial.
In a few weeks, at ACC.24, the PREVENT investigators will present the results of a multicenter, open-label, randomized…
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In EMPACT-MI, a randomized trial involving 6522 patients post-acute myocardial infarction, empagliflozin did not significantly reduce the combined outcome of heart failure hospitalization or death compared to placebo over a period of 17.9 months.
Once again, a drug that…
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Even in low-risk patients, TAVI carries some risk of stroke and major or life-threatening bleeding, challenging the selection of antithrombotic therapy. Which agent? When? For how long? The field of antithrombotic therapy for TAVI has essentially just begun.
#TCT2022
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The antiplatelet pretreatment recommendation is one of the most volatile I can think of in the guidelines for acute coronary syndromes. Each task force, essentially based on the same limited data available, has given significantly different interpretations over time.
#CRT2022
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Thanks to EAPCI and PCR for their trust, and warm thanks to those who sent me congratulatory remarks, here on
#cardiotwitter
and outside. I count on the support and enthusiasm of readers, authors, reviewers, editors and staff. We'll do our best to keep
@EuroInterventio
growing.
Congratulations to
@DFCapodanno
on being newly appointed as Editor-in-Chief of EuroIntervention.
He succeeds the co-founder of the Journal, Patrick W. Serruys! (effective as of 1 January 2020) 👏👏
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Times are changing. In this issue of Eurointervention, a State-of-the-Art review on coronary computed tomographic angiography as a first-line investigation in the diagnosis and decision-making for coronary artery disease.
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This mechanical thrombectomy device, called NeVa, has been designed to improve the incorporation and removal of large, organised thrombi. Here are the results of its first-in-human prospective study in patients with acute coronary syndromes.
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Following the ISCHEMIA trial and its impact on referrals, the mother of all the misunderstandings at the moment is the way in which interventionists and radiologists describe the percentage value of stenosis in their respective investigations: diameter vs. cross-sectional area.
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After 10 years to complete it, the DanGer-SHOCK trial showed that the routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone.
The…
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Where are we with drug-coated balloons (DCB) in PCI? Five thoughts.
1) The use of DCB in patients with in-stent restenosis, especially of a bare metal stent, is well established and evidence-based (now also in the US).
2) Conversely, DCB use in de novo disease lacks compelling…
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Seeing is believing. Contrary to common opinion, the proximal optimisation technique in bifurcation PCI results in significant elongation, rather than shortening, of the proximal stent segment. This has most relevance in case of left main PCI.
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I'm sure we can do better and feel free to disagree, but this is my tentative post-ISCHEMIA decision algorithm for patients with chronic coronary syndromes and angina, using symptoms evaluation and shared decision-making as the gatekeepers.
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The 2023 ESC guidelines for the management of acute coronary syndromes are online, for the first time reporting in the same document the recommendations for STEMI, NSTE-ACS and unstable angina.
#ESCCongress
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In the ISCHEMIA trial, an early invasive strategy was not better than a conservative strategy, and the presence of proximal LAD disease (47%) was not a treatment modifier. This is somewhat at odds with the current recommendation on "revascularization for prognosis".
#ESCCongress
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(1/3)
Top trials of 2019:
10th place: EXCEL. A trial that nobody strangely talks about.
9th place: GALILEO. Great trial, disastrous results.
8th place: ISAR-REACT 5. The mystery of the year.
7th place: PARTNER 3. Good for TAVR, but let's see at 5 years.
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Caffeine is a competitive antagonist of adenosine, but no standardized guideline exists on caffeine abstinence prior to FFR. This study demonstrated an almost linear relationship between serum caffeine level and adenosine-induced FFR overestimation.
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This is Glider, an ultra-short (4 mm) side branch dedicated balloon with an obliquely skived tip and a torqueable shaft. By combining POT and side branch dilation with this balloon, the idea is to skip final kissing and re-POT, simplifying bifurcation PCI.
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Provisional strategies, culotte or DK-crush? In this new free state-of-the-art review the authors describe technically important characteristics of bifurcation lesions and summarize the evidence and outcomes supporting contemporary bifurcation techniques.
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Current indications of direct oral anticoagulants in Europe, based on instructions for use. To date, there are four indications for dabigatran, six for rivaroxaban, three for apixaban, two for edoxaban, none for betrixaban.
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The 2022 ESC Guidelines on management of patients undergoing non-cardiac surgery are live, with revised flowcharts, a focus on biomarkers and peri-operative antithrombotic therapy, and new sections on cancer, frailty and patient perspectives.
#ESCcongress
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ORBITA-2, the revenge. In a randomized, placebo-controlled trial of 301 patients with stable angina who stopped all antianginal medications and had evidence of ischemia, the mean angina symptoms score at 12 weeks was lower with PCI than placebo.
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I'm back from Hot Lines session 4, which was entirely dedicated to intravascular imaging, with ILUMIEN IV, OCTOBER and ICTIVUS. Some results were conflicting, so a meta-analysis from
@GreggWStone
to summarize the state of the art was helpful. These were my comments.
#ESCCongress
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I know, I'm picky and the detail is insignificant, but I want to say that at a certain point in the chapter on lipid-reducing therapies of the new ESC guidelines for ACS the font switches to Times New Roman for no reason.
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In this proof-of-concept study, a novel device named Cusper, made of a nitinol clip with a pericardial sac, was tested for transcatheter aortic valve repair (TAVr) in ex-vivo and in-vivo porcine models of aortic regurgitation.
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Can we clear arterial atherosclerotic plaques?
The ACC.24 Late-Breaking Clinical Trials have been announced. My highlight is the large, phase 3, multicenter, double-blind, randomized, placebo-controlled AEGIS-II trial, a study of CSL112 (apolipoprotein A-I) infusion in patients…
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Trials of this year's
#AHA
that intrigue me the most:
1) SELECT on semaglutide
2) ORBITA-2 on PCI
3) DAPA-MI on dapagliflozin
4) AZALEA on abelacimab
5) ARTESIA on apixaban
6) REMAIN-2 on recaticimab
7) A trial of lepodisiran
8) VERVE-101 on gene editing
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In this Review, we provide an up-to-date overview on the use of P2Y12 inhibitor monotherapy after PCI, including supporting pharmacodynamic and clinical evidence, practical recommendations and future directions.
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DAPT is the standard of care after PCI for ACS. The randomized NEOMINDSET trial (N=3,400) is testing for the first time the hypothesis that immediate SAPT (e.g., aspirin drop) will be non-inferior to DAPT with respect to MACCE, and superior on bleeding.
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Over the last three days, we’ve seen almost all pharmacological strategies presented at
#ACC24
fail, including beta blockers, which seemed like the only certainty. On the contrary, if we are to believe in the results we've seen, we should start using more microaxial flow pump…
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EuroIntervention is pleased to share with you our free State-of-the-Art papers collection: high-level insights on general topics of interventional interest, written by top-class international experts, with many more to come. Do you have topics to suggest?
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In-depth knowledge and understanding of procedural steps, equipment, echocardiographic views, fossa ovalis anatomy and how to manage the most frequent complications is critical to performing a successful trans-septal puncture. A practical expert review.
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This meta-analysis of 25 trials and 4,467 patients undergoing cardiac surgery suggests that allowing pericardial effusion to drain freely into the left pleural space by posterior pericardiectomy reduces the risk of preoperative atrial fibnllation by 51%.
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Stents at the ostium of the right coronary artery are more prone to restenosis, but the mechanisms for this complication are poorly understood. New IVUS findings point towards stent fracture due to change in the ostial-aorta angle during the cardiac cycle.
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Multivessel disease affects approximately 50% of patients with ACS and is significantly burdened by poor outcomes and high mortality. We performed a systematic review of current evidence in the field, also including future perspectives from ongoing trials.
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Knowledge of the incidence, risk factors, prognosis and underlying pathophysiological mechanisms of MINOCA has developed significantly over the last decade. Yet, there are still fundamental gaps in our knowledge of this heterogeneous entity. A review.
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Presented at
#ESCCongress
, this study compared UFH pretreatment with no pretreatment in 41,631 STEMI patients undergoing primary PCI, showing a significant reduction in coronary artery occlusion with an NNT of 12 and no increased risk of major bleeding.
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TIME provides a clear answer on the question of whether blood pressure lowering medications should be taken in the morning or evening. People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them.
#ESCCongress
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Myocardial hibernation results from chronic low flow or repetitive episodes of stunning with metabolic adaptation. The myocardium remains viable and recovery of function occurs in weeks to months after revascularization.
Then, the REVIVED trial.
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The drug of the day is Tong Xin Lou, winner in CTS-AMI at
#AHA
with a 36% relative risk reduction in MACCE at 30 days in STEMI patients. A capsule includes ginseng, leeches, scorpions, red peony root, three types of earthworms, sandalwood, frankincense, suan zao ren and borneol.
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The PROMISE trial will investigate the improvement of angina in 180 MINOCA patients randomised 1:1 to a "precision-medicine" or "standard of care” approach. The results of this trial may pave the way for a new pathophysiology-driven approach to MINOCA.
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Increasing evidence has shown that coronary spasm and vasomotor dysfunction may be the underlying cause in more than half of myocardial infarctions with non-obstructive coronary arteries (MINOCA) as well as an important cause of chronic chest pain in the outpatient setting.
In…
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This review summarises the current knowledge on myocardial infarction with non-obstructive coronary arteries (MINOCA) including epidemiology, pathophysiology, investigation, treatment, gaps, and a special focus on imaging modalities.
#EIJTopCited
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This State-of-the-Art review discusses a standardised approach to evaluate patients with tricuspid regurgitation who may be candidates to the available transcatheter therapies, as well as main criteria for patient and device selection.
#EIJTopCited
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Watching live the streaming of the
#ISCHEMIA
presentation at the AHA costs about $500. Considering that on Twitter we'll know the results after 1 microsecond, I guess it's not worth it. Maybe, and I stress the maybe, I would spend $500 for a streaming of Mars landing.
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Crossing a resistant lesion or tortuosity is sometimes challenging even with guideline catheter extensions. This trapping technique called "TILT" requires an 8 Fr guide, a 5 Fr GuideLiner, a 2.5-3.5 mm semi-compliant balloon and a workhorse guidewire.
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I’m pleased to present the first issue of EuroIntervention in 2024, a long-awaited moment when I can finally share the developments we have been diligently preparing over the past few months. The primary – and most noticeable − transformation concerns the graphic design of our…
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If FAME-3 were the 100m run, it is like as if yesterday we were debating whether it is right to start the PCI 45 or 65m ahead to give it an acceptable advantage over surgery in three-vessel disease. Well, the news is that PCI started 65m ahead... and lost.
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While PCSK9 inhibitors like mAbs (evolocumab, alirocumab), siRNA (inclisiran) and small molecules (bembedoic acid) gain momentum, I'm fascinated and scared by this CRISPR/Cas9 permanent gene editing concept for lowering LDL cholesterol: "Fire and forget".
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Numerous studies have addressed the timing, selection, modulation and duration of P2Y12 inhibition in ACS and PCI. Our review tackles the evidence surrounding these questions, with a focus on data, practice guidelines, and residual areas of uncertainty.
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Multiple patient and procedural factors impact on the risk-benefit of antiplatelet and anticoagulant agents in acute and chronic coronary syndromes. Here is a brief summary of where we are with recommendations from the European Society of Cardiology in these areas.
#ESCCongress
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After MASTER DAPT, open questions include whether the results of the trial would be replicable using a different stent device, and which antiplatelet monotherapy should be used after discontinuation of DAPT.
#ESCCongress
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Today this paper saved a man's life. And it reminded me once more how important it is to study in this profession, to question any of your knowledge, and then study again. You never know when that thing you read might come in handy.
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STOPDAPT-2 ACS published in
@JAMACardio
. in patients with ACS and PCI, clopidogrel monotherapy after 1 to 2 months of DAPT did not meet noninferiority for NACE (at variance with ticagrelor monotherapy in TICO). The type of P2Y12 inhibitor matters, in ACS.
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In this richly illustrated and free access State-of-the-Art review the authors provide the rationale, summarise the evidence, and discuss current and future directions of antiplatelet treatment regimens after percutaneous coronary intervention.
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Statins, ezetimibe and PCSK9i, EPA, and beyond. Awaiting confirmation of benefit and safety in large cardiovascular outcome studies of new therapies for lowering lipid levels. The results of these trials may change the ways in which we will manage lipids in the non-near future.
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Did you know? Each circle represents 1 stent: the size is proportional to the number of trials with that stent and the number is the total of patients randomized. The edges represent direct comparisons between 2 stents and their width is proportional to the number of comparisons.
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Trials of P2Y12 inhibitors in cerebrovascular disease (noncardioembolic stroke or TIA). Clopidogrel monotherapy is recommended as first option (alternatives are aspirin alone or dipyridamole plus aspirin). Short DAPT (3 weeks) with clopidogrel or ticagrelor should be considered.
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It took 35 months, 1560 tweets and 532 followed accounts to reach 10000 followers on Twitter. It doesn't mean anything, but I wanted to thank you for taking the time to read.
#cardiotwitter
is a great educational resource. As we say in Italy... Grazie Diecimila. :)
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The initial diagnosis of MINOCA can be confirmed or ruled out based on the results of subsequent investigations. With this review we aimed at increasing the awareness that establishing the cause of a MINOCA is possible in the vast majority of cases.
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Weighing things such as findings, validity, impact and dissemination, these are my top 3 trials of 2020 in the interventional cardiology space (one per field: coronary, valvular, peripheral).
#GulfPCR
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Five year results of PARTNER 3 trial now published in the NEJM. Conclusions are based on the primary composite outcomes, but two aspects will be a reason for discussion, I guess: crossing of death curves, and the higher rate of valve thrombosis with TAVI.
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All ACS patients, except for those presenting with cardiogenic shock, should be offered complete revascularization. Enjoy an unlocked and most updated State-of-the-Art review on completeness of revascularisation in ACS patients with multivessel disease.
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In elective PCI, the updated story now tells that:
- in CREDO, clopidogrel reduced 1y MACE compared to placebo
- in SASSICAIA, prasugrel did not reduce 30d MACE compared to clopidogrel
- in ALPHEUS, ticagrelor did not reduce 48h periprocedural MI or injury compared to clopidogrel
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More than one year after the publication of the ISCHEMIA trial, I have the clear perception that coronary coronary computed tomography angiographies have increased significantly in my Institution. With them, wrong referrals to invasive coronary angiography have increased as well.
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PCI is increasingly performed in comatose survivors of out-of-hospital cardiac arrest who also undergo therapeutic hypothermia. A new study demonstrates that the incidence of definite stent thrombosis in these patients is substantial (19.2%).
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In 2021, we started a section entitled "State-of-the-Art" with the aim of offering you reviews on topics of wide interest in interventional cardiology and beyond. The result paid off greatly, so I would like to thank here the authors, reviewers and readers. More to come in 2022.
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Complete revascularization is now "a must" in ACS, but the optimal timing remains a matter of controversy: immediate? Staged in-hospital? Staged within 45 days? Staged when you want?
This prespecified analysis of the randomized BIOVASC trial suggests that immediate complete…
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Breaking news from Novo Nordisk. In the randomized, double-blind SELECT trial, semaglutide 2.4 mg as an adjunct to standard of care reduced MACE by 20% in 17,604 adults with established CVD with overweight or obesity and without prior history of diabetes. Let's wait for the NNT.
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