Persistently High Residual Inflammatory Risk Associated with Increased Mortality and MI Risk in Patients Undergoing PCI Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions

A recent study published in the European Heart Journal showed that a high percentage of patients undergoing percutaneous coronary intervention (PCI) had persistently high residual inflammatory risk (RIR). Moreover, high RIR was associated with increased all-cause mortality and myocardial infarction (MI) risk at 1 year of follow-up. Continue reading

Deciphering the Underpinnings of MINOCA (MI with Non-Obstructive Coronary Arteries) Results from the optical coherence tomography study

A new prospective observational study of 38 patients suffering from myocardial infarction with non-obstructive coronary artery disease (MINOCA) with the use of optical coherence tomography (OCT) and complementary cardiac magnetic resonance imaging (CMR) shows plaque disruption and thrombus account for one-fourth and one-fifth of MINOCA, respectively. Both plaque disruption and thrombosis were repeatedly found in coronary vessels supplying the infarct-related territory as confirmed by CMR. This is the first prospective study that successfully employed the use of OCT along with complementary CMR for studying the basic mechanisms leading to MINOCA suggesting that OCT may aid in deciphering the basic underpinnings of this not so rare type of myocardial infarction (MI).

MINOCA is increasingly being seen in clinical practice. Prior studies have served as a major effort to understand the pathophysiology of this presentation, which may aid in effective secondary prevention in this patient population. Several questions exist due to the heterogeneous nature of patients who suffer from MINOCA. Given this background, Opolski (Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland) and colleagues prospectively enrolled 38 patients (mean age 62 years; 55% women) with MI but <50 % stenosis on angiography (maximal diameter stenosis of 35%) in order to identify the mechanisms that lead to MINOCA. On OCT, nine patients (24%) showed signs of plaque disruption and seven (18%) had evidence of coronary thrombus. A per-lesion analysis of CMR results further demonstrated that, compared with non-infarct-related arteries, infarct-related arteries displayed more plaque disruption (40% vs 6%; P = 0.02), thrombus (50% vs 4%; P = 0.014), and thin-cap fibroatheroma (70% vs 30%; P = 0.03). Moreover, the investigators found that subjects with plaque disruption albeit non-significant tended to have numerically higher rates of ischemic late gadolinium contrast enhancement (LGE) on CMR than subjects without plaque disruption (50% vs. 13%, respectively; p = 0.053).

Utilization of OCT

Optical coherence tomography (OCT) is a high-resolution (10 to 15 mm) intracoronary imaging modality that employs the use of coherent light waves for precise assessment of the integrity of the atheromatous fibrous cap. This allows for visualizing plaques and thrombosis that may be otherwise missed on conventional angiography. In this study, the investigators aimed to perform OCT imaging in at least the coronary vessel that was suspected to be the culprit vessel (based on electrocardiography [EKG], echocardiography, and angiography).

Evaluation of Myocardial Injury on CMR

In this study, myocardial edema was evaluated as an area of high T2 signal intensity on a segmental basis (Left ventricle segments were defined by American Heart Association 17-segment model). The presence and pattern of late gadolinium enhancement (LGE) were determined for each segment and divided into subendocardial, subepicardial, midwall, or transmural. LGE in the subendocardial and transmural distributions were considered ischemic. Correlation between the coronary artery distribution and myocardial segments with LGE of ischemic origin served as a source of identification of infarct-related artery.


The study has its limitations since it was a small, single-center, and observational study. In addition, loss of eligible patients due to logistical problems and withdrawals of informed consent gives rise to selection bias. Furthermore, the investigators failed to perform 3-vessel OCT imaging in all patients, which could have resulted in a lower proportion of patients with plaque disruption and/or thrombus (specifically owing to a lower rate of OCT in the right coronary artery).

Emergency Department Chest Pain Volume Impacts Patient Outcomes Emergency Department Volume and Outcomes for Patients After Chest Pain Assessment

A study published in Circulation showed that the evaluation of chest pain in emergency departments with higher chest pain volume had lower rates of death or hospitalization for patients with acute coronary syndrome after discharge. The primary investigator, Dr. Dennis T. Ko and his colleagues also found that past a certain volume threshold, a rise in volume was not associated with any reduction in outcomes. Continue reading

PPIs for GI Bleeding Prophylaxis in Critically Ill ICU Patients: Benefits Vs Risks Results from the SUP-ICU trial

The use of Proton Pump Inhibitors (PPIs) for prophylaxis against gastrointestinal (GI) bleeding due to stress ulceration in critically ill patients admitted to the Intensive Care Unit (ICU) was not associated with improved mortality rate or fewer clinically important events, according to a new study published in the New England Journal of Medicine. Continue reading

Bariatric Surgery in Severe Obese Diabetics Associated with Lower Risk of Macrovascular Outcomes Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity

A retrospective cohort study performed by David P. Fisher and his colleagues was published in JAMA, showing that bariatric surgery in obese patients with diabetes was associated with a lower incidence of macrovascular events. Continue reading

Physical Fitness Associated with Lower Mortality? Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing

A recent study published in the Journal of American Medical Association showed that higher level of cardiorespiratory fitness (CRF) was associated with decreased long-term mortality with no observed upper limit of the CRF level that could induce the benefit. Moreover, extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension.  Continue reading

Assessment of Genomic MetaGRS Scoring System in Prediction of Coronary Artery Disease Genomic Risk Prediction of Coronary Artery Disease in 480,000 Adults

A study published by Journal of the American College of Cardiology described a genomic score having the potential to stratify the risk of coronary artery disease (CAD) and emphasized the possible use of genomic screening in early life, adding to traditional risk factors. Continue reading

Worse Clinical Outcomes of Atrial Fibrillation in Patients with HFpEF Compared to HFrEF Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry

A multinational prospective cohort study performed by Barak Zafrir et al. and published in the European Heart Journal concluded that worse cardiovascular outcomes of atrial fibrillation (AF) were associated with heart failure with preserved ejection fraction (HFpEF) and heart failure with middle range ejection fraction (HFmrEF) but not associated with heart failure with reduced ejection fraction (HFrEF). Continue reading

SGLT-2 Inhibitors Associated with Lower Heart Failure Hospitalization Tighter glycemic control is not associated with lower risk of HF hospitalization: A Meta-Analysis

A new meta-analysis published in the Journal of American College of Cardiology showed that sodium glucose co-transporter (SGLT)-2 inhibitors are more effective than glucagon-like peptide (GLP)-1 agonists and dipeptidyl peptidase (DPP)-4 inhibitors in reducing the risk of Heart Failure (HF) hospitalization in patients with type 2 diabetes mellitus. Continue reading

CoQ10 supplementation: A Remedy for Statin‐Induced Myopathy? Effects of Coenzyme Q10 on Statin‐Induced Myopathy: An Updated Meta‐Analysis of Randomized Controlled Trials

A meta‐analysis performed by Choi et al., the results of which were published in the Journal of the American Heart Association, indicated that CoQ10 supplementation improved statin‐associated muscle symptoms, suggesting a therapeutic approach for statin‐induced myopathy. Continue reading

Unrecognized Myocardial Infarctions Have a 10-Year Mortality Rate Comparable to Clinically-Recognized Infarctions Results form the ICELAND MI study

According to a new study published in the Journal of American Medical Association, unrecognized myocardial infarction (UMI) detected by cardiac magnetic resonance (CMR) was associated with equivalent all-cause mortality as compared to recognized myocardial infarction (RMI) at 10 years of follow-up. Individuals with UMI also had a higher risk of nonfatal MI, heart failure, and death than those without any evidence of MI. Continue reading

Atrial Fibrillation in a Cancer Setting: Understanding Unmet Needs in Cardio-Oncology Provider Specialty, Anticoagulation, and Stroke Risk in Patients With Atrial Fibrillation and Cancer

A new study by Neal et al. demonstrated that although patients with atrial fibrillation (AF) and cancer were less likely to see a cardiologist or fill anticoagulant prescriptions, cardiology involvement was associated with increased anticoagulant prescription fills and favorable AF-related outcomes. The results of the study were published online in JACC. Continue reading

From Barbershops to Churches: Are Community-Based Interventions the Best Way to Engage Vulnerable Populations? Cluster Randomized Clinical Trial of FAITH (Faith-Based Approaches in the Treatment of Hypertension) in Blacks

The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) has portrayed how a community-based lifestyle intervention delivered in churches can lead to a significantly greater reduction in systolic BP in hypertensive blacks in comparison with Health Education (HE) alone. The results were published online in Circulation. Continue reading

Variability in Metabolic Parameters: A Prognostic Surrogate Marker for MI, Stroke and Death? Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population

A study by Mee Kyoung Kim and her colleagues published in Circulation has shown that there is a graded association between the number of high variability parameters like fasting blood glucose and total cholesterol levels, systolic blood pressure, and body mass index and cardiovascular outcomes. They showed that the mentioned variables may be considered as independent predictors of mortality and cardiovascular events. Continue reading

GLP-1 Receptor Agonist Albiglutide Demonstrates ‘Harmonious’ Cardiovascular Outcomes in Type 2 Diabetics Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease : The HARMONY OUTCOMES trial

The results of the recently published Harmony-Outcomes study in The Lancet, led by Professor Stefano Del Prato, University of Pisa, Italy and Professor John McMurray, University of Glasgow, UK, have demonstrated that among patients with concomitant type 2 diabetes and cardiovascular disease, albiglutide, a glucagon-like peptide 1 receptor agonist is superior to placebo in the reduction of major adverse cardiovascular events. The study suggests that evidence-based glucagon-like peptide 1 receptor agonists should be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Continue reading

Anticoagulant and Antiplatelet Therapy in Stented Patients with Atrial Fibrillation Combining Oral Anticoagulants With Platelet Inhibitors in Patients With Atrial Fibrillation and Coronary Disease

In an article published in the Journal of the American College of Cardiology, authored by Caroline Sindet-Pederson, MSc, and colleagues in the Department of Cardiology at Copenhagen University Hospital Herlev and Gentofte in Hellerup, Denmark, evaluating a real-world population of AF patients with MI and/or after PCI, the use of direct oral anticoagulants (DOAC) as compared to VKA reduced the risk of bleeding in patients also taking dual antiplatelet therapy (DAPT). Continue reading

Periprocedural loading dose of Atorvastatin reduces MACE in patients with ACS undergoing PCI: Is this a Pleiotropic effect? Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: Insights From the SECURE-PCI Randomized Clinical Trial

A study by Lopes and his colleagues published in JAMA Cardiology has shown that in patients with ACS undergoing PCI, periprocedural loading doses of atorvastatin appeared to reduce the rate of Major Adverse Cardiovascular Events (MACE) at 30 days, primarily in patients with ST-segment elevation myocardial infarction. Insights from the Statins Evaluation in Coronary Procedures and Revascularization (SECURE-PCI) randomized clinical trial showcased this beneficial effect to be preserved and consistent, regardless of the timing of atorvastatin administration, including within 2 hours before PCI. Continue reading

Same Day Discharge Following Elective PCI Proven Both Safe and Economical Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

An observational cross-sectional cohort study by Amin et al. suggested that greater and more consistent use of same-day discharge(SDD) following elective percutaneous coronary intervention (PCI) is the United States, could markedly increase the overall value of PCI care. Apparently, SDD was not only safe but associated with large savings of more than $5000 per PCI. Continue reading

Top 10 Cardiology Now Stories for September

1. COAPT  Demonstrates the Benefit of Transcatheter Mitral-Valve Repair Using MitraClip in Patients with Heart Failure

The trial demonstrated that transcatheter mitral valve approximation using the MitraClip, on a background of maximally tolerated guideline-directed medical therapy (GDMT) was superior to GDMT alone in the reduction of Heart Failure (HF) hospitalization and mortality in symptomatic HF patients with grade 3-4+ Mitral regurgitation. Continue reading

Vascular Video Series Part 9: AHA’s Goal for Reducing Cardiovascular Death by 20% in 2020 Dr. Libby, Dr. Bonaca, and Dr. Gibson Discuss

This video is supported by an unrestricted educational grant.