Coronary CTA Provides an Unrivaled Opportunity for More Detailed Analysis in Selected Patients, According to a Study Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

According to a recent publication in the Journal of the American College of Cardiology, in diabetic patients presenting with stable chest pain, a computed tomographic angiography (CTA) strategy resulted in fewer adverse cardiovascular outcomes in comparison with a functional testing strategy. The conclusions drawn from the study implied that CTA may be considered as the initial diagnostic modality in this subgroup. Continue reading

AVERT: Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients

A study by Marc Carrier and his colleagues published in the New England Journal of Medicine concluded that apixaban therapy resulted in a significantly lower rate of venous thromboembolism as compared to placebo among intermediate-to-high-risk ambulatory patients with cancer who were starting chemotherapy. According to the publication, the investigators also confirmed that the rate of major bleeding episodes was higher with apixaban than with placebo. Continue reading

Early and Late Leaflet Thrombosis Following TAVR A Multicenter Initiative From the OCEAN-TAVI Registry

A real-world multicenter study by Yanagisawa and his colleagues published in Circulation: Cardiovascular Interventions reported that untreated early leaflet thrombosis did not affect the cumulative event rates of death, stroke, and rehospitalization for heart failure. The investigators also stressed on the fact that late leaflet thrombosis was newly detected in patients during the 3-year follow-up period.  Continue reading

Statin vs Healthy Adherer Effect On Mortality in ASCVD Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease

In a vigorous retrospective cohort study published in JAMA, Fatima Rodriguez et al. found an inverse graded association between long-term statin adherence and all-cause mortality using a nationwide sample of the Veterans Affairs Health System, in patients with atherosclerotic cardiovascular disease(ASCVD). The study proposed that there was room for improvement in statin adherence and also stressed on its importance as a measure of secondary prevention of ASCVD. Continue reading

Impaired Microvascular Function Predicts Adverse Cardiovascular Outcomes in Women with Signs and Symptoms of Ischemia: Understanding the ‘Feminine Face’ of Ischemic Heart Disease Impact of Abnormal Coronary Reactivity on Long-Term Clinical Outcomes in Women

Investigators Ahmed Al Badri and C. Noel Bairey Merz from the Cedars Sinai Smidt Heart Institute, in Los Angeles, California recently reported that on longer-term follow-up in women, impaired microvascular function predicted adverse cardiovascular outcomes in patients with signs and symptoms of ischemia. In their publication in JACC, they concluded that evaluation of coronary reactivity (CR) abnormality could identify those at higher risk of adverse outcomes in the absence of significant coronary artery disease (CAD). Continue reading

Statins Shown to Reduce Major Adverse Cardiovascular Events in Patients Older Than Seventy Five Years Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials

HMG-CoA reductase inhibitors or as they are commonly known as statins have been postulated to produce significant reductions in major vascular events irrespective of age, but their efficacy and benefit among patients older than 75 years have not been well documented. In a recent meta-analysis published in The Lancet, by The Cholesterol Treatment Trialists’ Collaboration (CTT collaboration), the influence of advancing age and statin therapy on major vascular episodes in 28 statin trials was analyzed. The collaboration found that statins do reduce the risk of vascular events in older people but have no effect, irrespective of age, on non-vascular mortality and cancer incidence. In the past, 14 meta-analyses have been done each with inconsistent evidence about the use of statins among older people (generally >65 years). This gap in evidence concerning the perception of risk-benefit for the use of statins as the primary prevention in people older than 75 years may be one of the reasons explaining why statin therapy is often discontinued in older patients. Unlike these studies, the present meta-analysis conducted by the CTT collaboration analyzed individual participant data from randomized controlled trials of 186, 854 participants who were older than 75 years with a median follow-up of 4·9 years. Continue reading

Vasodilator Stress Cardiac Magnetic Resonance Imaging Shows Promise in the Identification of Fatal Heart Disease Prognostic Value of A Multicenter Study With 48 000 Patient-Years of Follow-up

The findings of a study by Heitner et al. published online on February 8  in JAMA cardiology has provided a foundational motivation to study the comparative effectiveness of stress CMR (Cardiac Magnetic Resonance) against other modalities. The study found that clinical vasodilator stress CMR is associated with patient mortality in a large, diverse population of patients with known or suspected CAD as well as in multiple subpopulations defined by a history of CAD and left ventricular ejection fraction. Although the utility of MRI to determine heart function has been slow to catch on, this study performed by Duke Health researchers showcased how stress cardiac MRI not only diagnosed disease but could also predict which cases would be potentially fatal.  Continue reading

Microvascular and Endothelial Dysfunction Found in Nonculprit Artery In Over Ninety Percent of STEMI Patients, According to a Study

Findings of a study published in Circulation: Cardiovascular Interventions reflected that microvascular and endothelial dysfunction in the non-culprit artery territory in patients with STEMI were very common. Additionally, in 93% of the patients, functional abnormalities were found. Moreover, the investigators of the study also concluded that acetylcholine administration in the early phase post-STEMI in patients with multivessel disease was safe. Continue reading

Hospitalizations for Stroke Associated With Infective Endocarditis and Opioid Use: National Trends

A recent study published in Circulation Stroke conducted by Omran et al. reported that the US hospitalization rates for stroke associated with infective endocarditis and opioid use were stable for roughly about 2 decades but then sharply increased in 2008, coinciding with the emergence of the opioid epidemic. Continue reading

EuroCTO: A Simple Scoring System to Predict Technical Success when Performing CTO PCI Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score

A study by Zsolt Szijgyarto and his colleagues published in JACC: Cardiovascular Interventions has derived the EuroCTO (CASTLE) from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcomes. The investigators stated that previous CABG, age over 70 years, a blunt stump, severe tortuosity, length of the occlusion, and the extent of calcification were strongly associated with unsuccessful CTO-PCI. Continue reading

Does Aggressive Control of Blood Pressure Decrease the Risk of Cognitive Impairment? Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia- A Randomized Clinical Trial

So far, there has been no definitive treatment for dementia. There are medications that provide symptomatic relief but there has been an advance towards developing disease-modifying medications. Due to the long preclinical period of most neurodegenerative diseases, prevention as a mode of treatment seems to be an important area of exploration. The relation between high blood pressure and cognitive impairment is one important aspect. In a recent randomized controlled trial called Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study published in JAMA NETWORK, researchers from the SPRINT group embarked to ascertain if intensive blood pressure control could decrease the risk of Alzheimer disease and related dementias. This was the first trial ever to demonstrate an effectual strategy for preventing of age-related cognitive impairment as it compared the effectiveness of intensive blood pressure control (targeting a systolic blood pressure of less than 120 mm Hg) to standard blood pressure control (targeting a systolic blood pressure of less than 140 mm Hg) towards the prevention of probable dementia. Continue reading

Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants Are Associated With Similar Lower Risk of Coronary Heart Disease, Says a New Study

A study by Ference et al. published in JAMA showed that triglyceride-lowering LPL variants and LDL-C–lowering LDLR variants were associated with similar lower risk of CHD per unit difference in ApoB. Therefore, the investigators believe that the clinical benefit of lowering triglyceride and LDL-C levels may be proportional to the absolute change in ApoB. Continue reading

Early Switch from Intravenous to Oral Antibiotic Therapy for Left-Sided Endocarditis POET trial (Partial Oral Treatment of Endocarditis)

Among patients who had left-sided infective endocarditis (IE) caused by common bacteria, a shift from intravenous (IV) to oral antibiotic treatment was noninferior to continued IV antibiotic treatment, according to the open-label, randomized POET trial (Partial Oral Treatment of Endocarditis; NCT01375257). Contemporary practice guidelines from the US and Europe recommend a 4- to 6-week course of IV antibiotics for patients with a left-sided IE. Data from the POET trial suggest that oral antibiotics may be safely and effectively administered during approximately half of the recommended treatment period, and potentially as outpatient treatment. The study results were presented at the European Society of Cardiology Congress 2018 and published in the New England Journal of Medicine.

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Randomized Trial Comparing Bilateral with Single Internal-Thoracic-Artery Grafting for CABG Shows No Significant Difference in All-Cause Mortality Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years

A recent study published in the New England Journal of Medicine showed that among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Coronary-artery bypass grafting (CABG) surgery with the use of left internal- thoracic-artery grafts plus vein grafts had been deemed superior to percutaneous coronary intervention in patients with severe coronary artery disease and in those with diabetes. The benefit of using left internal thoracic artery grafts has been attributed to their superior long-term patency as compared with vein grafts. However, it is hypothesized that multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. In the light of this, the study aimed to evaluate the use of bilateral internal-thoracic-artery grafts for CABG. Continue reading

Debunking Extreme Exercise and Coronary Artery Calcification: Can Those with ‘Hearts of Stone’ Run to Death? A Recent Study Says No Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification

Evidence suggests that men with high physical activity have higher levels of coronary artery calcification (CAC), but very little data is available on whether these men should continue to exercise and whether they have a higher risk of mortality. A recent study published in JAMA Cardiology by Dr. Laura F. DeFina and her colleagues from the Cooper Institute in Dallas, answers the important questions of whether extreme physical activity is injurious to health and if there is an association between increased CAC and clinical events. In short, their answer was no. Continue reading

Aspirin Use for Primary Prevention Associated With Lower Risk of Cardiovascular Events and an Increased Risk of Major Bleeding A Systematic Review and Meta-analysis

An original investigation by Zheng et al. published in JAMA showed that the use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding.  This may assist in discussions with patients about aspirin for the primary prevention of cardiovascular events and bleeding.

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