Patients with intracoronary imaging-defined vulnerable plaques (VP) have a higher risk of experiencing major adverse cardiac events.1 While optimal medical therapy (OMT) is the standard approach to stabilize plaque vulnerability, the effectiveness and safety of focal preventive percutaneous coronary

In the treatment of coronary artery disease (CAD), fractional flow reserve (FFR) can be performed during coronary angiography to evaluate the need for percutaneous coronary intervention (PCI).1 Nevertheless, the efficacy of wire-based FFR is constrained by its practical limitations.1,2 Computational

Mixed data have been observed on the role of statins in the preventative setting of cardiovascular disease (CVD).¹ However, Dr. Raffaele Bugiardini, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Italy and his colleagues conducted a recent study published in the Journal of the American College of Cardiology, which demonstrated evidence that receiving statin therapy before initial acute coronary syndrome (ACS) could reduce acute heart failure (AHF) and improve patient survival rates.²

Acute myocardial infarction (AMI) is caused by large coronary plaques characterized by a lipid-rich pool covered by a thin fibrous cap, and visualized by intracoronary imaging.¹ Alirocumab, a PCSK9 inhibitor, lowers low-density lipoprotein cholesterol (LDL-C) and reduces the risk of major cardiovascular (CV) events in stabilized acute coronary syndrome (ACS) patients.1 However, these patients remain at an increased risk of recurrent thrombosis due to high-risk plaques.¹

Ticagrelor continues to be one of the often-used antiplatelet drugs in the management of acute coronary syndrome (ACS), however only 10% of the ACS patients treated with ticagrelor require coronary artery bypass surgery (CABG) due to perioperative bleeding.¹ The current North American guidelines (Including ACC/AHA) advocate a waiting period of at least 5 days after ticagrelor cessation prior to non-urgent CABG, and the 2017 European Society of Cardiology (ESC) guidelines also recommend a waiting period of at least 3 days after ticagrelor cessation for non-urgent CABG. However, from the real-life clinical point of view, it is hypothesized that early surgery is noninferior to delayed surgery for severe or massive perioperative bleeding. Therefore, the RAPID CABG trial, a physician initiated multi-centre randomized study, was conducted to evaluate the safety of early CABG surgery after a shorter ticagrelor cessation of 2 to 3 days as compared to 5 to 7 days prior CABG, among 143 patients presenting with ACS who require non emergent CABG.¹ Primary endpoint was severe/ massive bleeding by the Universal Definition of Perioperative Bleeding (UDPB): Class 3 or 4.

The results from a 6-month follow-up of RAPID CABG trial indicated patients could discontinue ticagrelor 2 to 3 days prior to CABG without increasing the risk of early post-surgical bleeding and could also reduce the average length of hospital stay.

The new European Society of Cardiology (ESC) guidelines for the diagnosis and management of chronic coronary syndromes (CCS) were presented at the ESC congress 2019 in Paris, France. These new guidelines, which updated those published in 2013, have been revised to focus on CCS instead