2018: Cardiology News at A Glance Most important trials published in 2018

COAPT trial

This prospective, multicenter, open-label, randomized trial aimed to assess the use of transcatheter mitral valve repair in heart failure (HF) patients with mitral regurgitation due to left ventricular dysfunction. A total of 614 patients were randomized to either receiving guideline-directed medical therapy (GDMT) alone or GDMT in addition to transcatheter mitral-valve repair. The primary efficacy endpoint was all hospitalizations due to heart failure at 24 months of follow-up, while the primary safety endpoint was freedom from device-related complications at 12 months of follow-up. The study showed that the device group had a lower risk of hospitalization for HF (HR 0.53, 95% CI 0.4-0.7) and all-cause mortality (HR 0.62, 95% CI 0.46-0.82) at 24 months. Moreover, the rate of freedom from device complications at 12 months was 96.6% which exceeded the prespecified safety threshold. Continue reading

ILLUMENATE European RCT Demonstrates Durability of Low-Dose DCB in Humans For the First Time Sustainable Antirestenosis Effect With a Low-Dose Drug-Coated Balloon: The ILLUMENATE European Randomized Clinical Trial 2-Year Results

The two-year results of the ILLUMENATE European randomized clinical trial conducted by Brodmann and her colleagues have displayed a sustained treatment effect with a low-dose drug-coated balloon (DCB) with an optimized coating formulation. This trial, published in JACC Cardiovascular Interventions, has demonstrated, for the first time, a statistically significantly higher primary patency rate for a low-dose DCB versus PTA at 2 years. Continue reading

Novel Target for STEMI Patients: Cholesterol Efflux Capacity Inversely Associated with All-Cause Mortality Population-based cohort study shows patients with a higher serum cholesterol efflux capacity have a significantly marked decrease in all-cause mortality

A population-based cohort study has shown that patients with a higher serum cholesterol efflux capacity, the capacity of HDL particles to mediate cholesterol efflux from macrophages, have a marked decrease in all-cause mortality as compared to patients with a lower serum cholesterol efflux capacity. Continue reading

Major Bleeding Rates With Antithrombotic Therapy in Atrial Fibrillation  Results from a Nationwide Danish Cohort Study

The results of a study conducted by Rein et al. have shown that patients with atrial fibrillation on triple therapy experienced high rates of major bleeding compared with patients on dual therapy or monotherapy. The high bleeding rates observed in patients on triple therapy over the age of 90 years or with a CHA2DS2-VASc score over 6 or with a history of a major bleeding warranted careful consideration of such therapy in these patients. The results were published online ahead of print in Circulation. Continue reading

Lifetime Stroke Risk From Age Twenty Five Onwards Is Approximately One-Fourth and Varies Geographically, According to A New Study Study Determines Lifetime Risk of Stroke at Regional, National, and Global Level: 1990 and 2016

A study conducted by the GBD 2016 Lifetime Risk of Stroke Collaborators demonstrated that the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. Moreover, there was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. The results were published in the New England Journal of Medicine. Continue reading

Coronary Artery Calcium Scoring: A Screening Tool For Statin Prescription In the Primary Prevention of Cardiovascular Disease? Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring

According to a new study published in the Journal of American College of Cardiology, patients with higher coronary artery calcium (CAC) scores were more likely to achieve benefit from statins in the primary prevention of cardiovascular disease. Continue reading

Long-Term Risk of Death Shows Dramatic Increase Following Femoropopliteal Application of Paclitaxel-Coated Balloons and Stents A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The results of a systematic review and meta-analysis of randomized controlled trials conducted by Konstantinos Katsanos and his colleagues have showcased an increased risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the lower limbs. Further investigations are urgently warranted, the authors state in their publication in Circulation. Continue reading

‘CONSERVE’ Your Energy and Resources: Selective Referral Strategy Using CCTA Non-Inferior to Direct Referral Strategy to ICA for Suspected CAD CONSERVE Trial: A Randomized, Controlled, Open-Label Trial

The findings of a randomized, controlled, open-label trial conducted by Dr. Hyuk-Jae Chang, Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea and his colleagues, has reported that in stable patients with suspected coronary artery disease (CAD) who are eligible for invasive coronary angiography (ICA), the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy were suggestive that both diagnostic approaches were similarly effective. Moreover, in the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of coronary computed tomographic angiography (CCTA) as an efficient and accurate method to guide decisions of ICA performance. The findings were published online in JACC: Cardiovascular Imaging. Continue reading

The Hunt for an HIV Vaccine Dr. Kathryn Stephenson and Dr. C. Michael Gibson Discuss

Does One Need A Parachute While Jumping From An Aircraft? A Clinical Trial Addresses the Question Results from the PARACHUTE trial

Parachute use on jumping from an aircraft does not reduce death or major traumatic injuries when compared with jumping with empty backpacks, according to a new trial published in the British Medical Journal. Continue reading

ICU Stethoscopes Foster DNA from Nosocomial Bacteria

A molecular analysis of bacterial contamination on stethoscopes in an intensive care unit conducted by Vincent R. Knecht and his colleagues at University of Pennsylvania Perelman School of Medicine, Philadelphia, has shown that stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities. Continue reading

Flu Shot Linked to Heart Failure Survival Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study

Patients with heart failure (HF) who receive influenza vaccination may be at a lower risk of both all-cause mortality and cardiovascular death after adjustment for confounders, according to a large-scale observational nationwide study of Danish citizens. “Annual influenza vaccination may be an effective treatment strategy to improve survival in heart failure,” lead author Daniel Modin (Department of Cardiology, Herlev & Gentofte Hospital, Denmark), and colleagues wrote in their paper recently published in Circulation. Continue reading

Chronic Red Meat Consumption Associated With Increased TMAO Concentrations TMAO: Associated With Increased Risk of Atherosclerosis and CVD

A recent study published in the European Heart Journal showed that chronic red meat consumption is associated with increased serum and urine concentrations of trimethylamine N-oxide (TMAO), a metabolite associated with increased risk of atherosclerosis and cardiovascular disease (CVD), when compared to white meat and non-meat sources of protein. Continue reading

Groundbreaking Study: The PARACHUTE Trial – The World’s First Multi-Center Block Permutation Randomized Control Trial of Parachute vs No-Parachute While Jumping from an Aircraft Dr. Robert Yeh, Dr. Dhruv Kazi, Dr. Duane Pinto and Dr. Gibson Discuss

Left Main PCI With DES Versus CABG: PCI Shows Similar Rates of Death, But a Higher Rate of Target-Vessel Revascularization at Ten Years 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease

A study by Duk-Woo Park et al. has shown that in patients with significant left main coronary artery (LMCA) disease, as compared with CABG, PCI showed similar rates of death and serious composite outcomes, but a higher rate of target-vessel revascularization at 10 years. Moreover, they demonstrated that CABG showed lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years. Continue reading

Lesser Training In Amateur Marathon Runners Can Lead to Raised Troponins Elevation of Cardiac Troponins After Endurance Running Competitions

A recent article published in Circulation by John Del Coso and his team demonstrated that the cardiac stress during a marathon is higher than the cardiac stress produced by competing in shorter-distance events, at least in athletes with lesser experience and lower training background. The manuscript provides evidence of the relatively-high cardiac stress of marathoners, following a competition.  Reasons for this high cardiac stress after the marathon arise from the combination of a long distance event and the lack of appropriate training in the study sample. Interestingly, athletes with lower running experience and training backgrounds presented much lower values of cardiac stress, as they decided to compete in shorter distances. Continue reading

Drug-Coated Balloon Outperforms Percutaneous Transluminal Angioplasty in Femoropopliteal Disease 24-Month Results of AcoArt I

A study conducted by Yongle Xu et al. demonstrated that the superiority of Drug-Coated Balloon (DCB) versus percutaneous transluminal angioplasty (PTA) in the efficacy of femoropopliteal artery disease (FPAD) treatment persists at 24-month follow-up. The findings, which were published online in JACC: Cardiovascular Interventions, also showed that the safety of DCB was equivalent to that of PTA. Continue reading

Top-Ranked Hospitals Have Better Survival Rates, But Not Necessarily A Lower Risk of Readmission Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

Cardiology patients treated in hospitals at the top of U.S. News & World Report rankings had better survival rates, but not necessarily less risk of readmission, researchers found. This study by Wang and his colleagues found that US News & World Report  (USNWR) top-ranked hospitals for cardiovascular care had lower 30-day mortality rates for AMI, HF, and CABG and higher patient satisfaction ratings compared with non-ranked hospitals. However, 30-day readmission rates were either similar (for AMI and CABG) or higher (for HF) at top-ranked compared with non-ranked hospitals. This discrepancy between readmissions and other performance measures raised concern that readmissions may not be an adequate metric of hospital care quality. Continue reading

Endocarditis Persists Five Years After Transcatheter Deployment of Melody Valve Prosthesis in Pulmonary Position

The results of a study conducted by Doff B. McElhinney and his colleagues published in JACC showed that endocarditis is an important adverse outcome following Transcatheter Pulmonary Valve Replacement (TVPR) in children and adults with postoperative congenital heart disease involving the right ventricular outflow tract (RVOT). Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. Continue reading

Does Race/Ethnicity Affect Oral Anticoagulant Use in Patients With Atrial Fibrillation? Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II

A study by Essien and his colleagues published in JAMA aimed to determine if there were racial/ethnic differences in the use of oral anticoagulants, particularly direct-acting oral anticoagulants (DOACs), in patients with atrial fibrillation. The findings showcased the fact that after controlling for clinical and socioeconomic factors, black individuals were less likely than white individuals to receive DOACs for atrial fibrillation, with no difference between white and Hispanic groups. Continue reading