Complete Revascularization of Stable STEMI Patients Offers a Significant Benefit if Done During the Index PCI, but Not if It\u27s Done as a Staged Procedure

Background: Complete revascularization (CR) of hemodynamically stable STEMI improves outcomes when compared to culprit-only PCI. However, the optimal timing for CR (CR during index PCI [iCR] versus staged PCI [sCR]) is unknown. sCR is defined as revascularization of non-culprit lesions not done during the index procedure (mean 31.5±24.6 days after STEMI). Our goal was to determine whether iCR was the superior strategy when compared to sCR. Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs reporting outcomes of stable STEMI patients who had undergone CR. Only RCTs with a clearly defined timing of CR, for the classification into iCR and sCR, and a follow-up of at least 12 months were included. Seven RCTs comprising 6647 patients (mean age:62.9±1.4 years, male sex:79.4%) met these criteria and were included. Results: After a mean follow-up of 25.1±9.4 months, iCR was associated with a significant reduction in cardiovascular mortality (risk ratio [RR] 0.48, 95% confidence interval [CI] 0.26-0.90, p=0.02, relative risk reduction [RRR] 52%) and non-fatal reinfarctions (RR 0.42, 95% CI 0.25-0.70, p=0.001, RRR: 58%). sCR showed a significant reduction in non-fatal reinfarctions only (RR 0.68, 95% CI 0.54-0.85, p=0.0008, RRR: 32%). There was no difference in the safety outcome of contrast-induced nephropathy between groups. Conclusion: iCR of stable STEMI patients is associated with a significant reduction in cardiovascular death and a trend towards reduction in all-cause mortality. These benefits are not seen in sCR. Both strategies are associated with a reduction in non-fatal reinfarctions

Bundle branch reentrant ventricular tachycardia: review and case presentation

Bundle branch reentrant ventricular tachycardia (BBRVT) is characterized by a unique, fast (200-300 beats/min), monomorphic wide complex tachycardia (WCT) associated with syncope, hemodynamic compromise, and cardiac arrest. It is challenging to diagnose, requiring a His bundle recording and specific pacing maneuvers. The overall incidence has been reported to be up to 20% among patients with non-ischemic cardiomyopathy (NICM) undergoing electrophysiologic studies. We report a case of BBRVT in a patient with ischemic cardiomyopathy (ICM) presenting as a WCT with recurrent implantable-cardioverter-defibrillator (ICD) shocks. We describe all the characteristic features of BBRVT and discuss its differential. We also discuss the role of ablation for this condition

POSTPROCEDURAL MONOTHERAPY WITH ASPIRIN VS DAPT AFTER TAVI - AN UPDATED META-ANALYSIS OF RANDOMIZED, CONTROL TRIALS

Background: Multiple studies have evaluated whether monotherapy with aspirin is superior to DAPT in patients who have undergone transcatheter aortic valve implantation (TAVI). Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs that reported outcomes of patients undergoing TAVI who received post-procedural aspirin only vs those who received DAPT. Four RCTs met the eligibility criteria. Results: This meta-analysis includes 1,086 patients with a mean age 80.0±0.75 years; 50.3% were male. After a mean follow-up of 9.0±3.5 months, there was a significant benefit in the aspirin only group, when compared with the DAPT group, in all bleeding events (Risk Ratio [RR] 0.58, 95% Confidence Interval [CI] 0.44-0.76, p\u3c0.0001, relative risk reduction [RRR] 42%, absolute risk reduction [ARR] 9.1%). No statistically significant differences between groups were found in the other outcomes: all-cause mortality (RR 1.01, 95% CI 0.63-1.61, p=0.97), cardiovascular mortality (RR 1.07, 95% CI 0.54-2.12, p=0.84) or all stroke (RR 0.93, 95% CI 0.54-1.61, p=0.79). Conclusion: Monotherapy with aspirin following TAVI is associated with a lower risk of all bleeding events when compared with post-procedural DAPT. No differences between groups were seen in the other studied outcomes. However, the short mean follow-up period is an important limitation of the present study. Further studies with longer follow-up periods are needed before changes are implemented in the current TAVI guidelines%