Myocardial revascularization strategies in diabetic patients with multi-vessel disease: CABG vs DES-based PCI.

Randomized trials comparing multi-vessel percutaneous coronary intervention to coronary artery bypass grafting (CABG) have demonstrated the long-term superiority of CABG in diabetic patients. Benefits include improved survival, fewer recurrent myocardial infarctions and a lower risk of the need for repeat intervention. The focus of this review article is to review the contemporary management of diabetic patients with multi-vessel coronary artery disease

Omitting aspirin in PCI patients: Myth or reality?

In the current era of percutaneous coronary intervention (PCI), with the use of contemporary drug-eluting stents, refined techniques, and adjunctive pharmacotherapy, the role of aspirin peri-PCI remains undisputable. Beyond the initial period, dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor inhibitor for 6 months in stable coronary artery disease and 12 months in acute coronary syndromes is the standard of care. However, concerns regarding bleeding adverse events caused by aspirin have led to shortened DAPT duration or even omission of aspirin. Aspirin free-strategies have been increasingly encountered in several studies and showed a significant reduction in bleeding events, without any sign of increased ischemic risk. Individualization of DAPT duration particularly in high bleeding risk patients appears therefore mandatory, making aspirin not necessary in several cases. Moreover, recent randomized trials have shed light on how to treat PCI patients in the presence of concomitant anticoagulant treatment with P2Y12 monotherapy and excluding aspirin. These aspirin-free strategies have been proved safer than the “older” standard triple antithrombotic treatment, without compromising safety. Ongoing studies may further dispel the myths and establish real facts regarding post-PCI-tailored treatment with or without aspirin. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Myocardial revascularization strategies in diabetic patients with multi-vessel disease: CABG vs DES-based PCI.

Randomized trials comparing multi-vessel percutaneous coronary intervention to coronary artery bypass grafting (CABG) have demonstrated the long-term superiority of CABG in diabetic patients. Benefits include improved survival, fewer recurrent myocardial infarctions and a lower risk of the need for repeat intervention. The focus of this review article is to review the contemporary management of diabetic patients with multi-vessel coronary artery disease

Aspirin hypersensitivity in patients undergoing percutaneous coronary intervention. What should we be doing?

Aspirin plays a pivotal role in the management of patients with Coronary Artery Disease (CAD) with well-recognised benefits of reducing recurrent myocardial infarction and minimising the risk of stent thrombosis for those undergoing Percutaneous Coronary Intervention (PCI). Dual antiplatelet therapy is mandated for patients undergoing PCI and typically consists of aspirin and a P2Y12 receptor antagonist. Aspirin hypersensitivity poses a significant clinical dilemma, as the safety and efficacy of oral antiplatelet combinations that exclude aspirin have not been validated. Although, genuine hypersensitivity to aspirin is encountered infrequently, it can be challenging when managing patients with concomitant CAD given the paucity of safe and effective alternatives. Aspirin desensitization is a potential and safe option but may not always be practical. This review aims to highlight the challenges of aspirin hypersensitivity in patients undergoing PCI and propose a treatment algorithm to address this issue in clinical practice. © 2019 Bentham Science Publishers