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

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

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

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

New TAVR Insights: Survival Advantage of TAVR Over SAVR Not Sustained At Five Years, Severe Prosthesis-Patient Mismatch Not Benign Following TAVR

The 5-year outcomes of a trial conducted by Gleason et al. published in JACC demonstrated a similar safety profile, functional recovery, and freedom from severe structural valve deterioration (SVD) for both TAVR and SAVR, consistent with earlier-term reports. These outcomes supported TAVR as a reasonable alternative to SAVR in the high-risk population and its current Class I indication. Continue reading

Coronary Physiology Beyond Coronary Flow Reserve: A Giant Leap in the Understanding of Coronary Microvascular Disease A JACC State-of-the-Art Review

In a JACC State-of-the-Art Review by Dr. Lance Gould and his colleagues at UTHealth, Houston, Texas, the pathophysiology of Coronary microvascular disease (CMD) was summarized and an update was provided of diagnostic testing strategies, and classification of CMD into phenotypes according to severity and coexistence with atherosclerosis. Moreover, emerging data highlighting the significance of CMD in specific populations, including obesity and insulin resistance, myocardial injury and heart failure with preserved ejection fraction, and nonobstructive and obstructive coronary artery disease were analyzed. Lastly, the role of CMD as a potential target for novel interventions beyond conventional approaches, representing a new frontier in cardiovascular disease reduction was explored.  Continue reading

Diagnosis of Frailty in a Patient with Acute Myocardial Infarction Helps Personalize an Approach to Optimize Outcomes The Association of Frailty With In-Hospital Bleeding Among Older Adults With Acute Myocardial Infarction: Insights From the ACTION Registry

In a report in this issue of the JACC: Cardiovascular Interventions, Dr. John A Dodson and his colleagues from the New York University School of Medicine reported that frail patients had lower use of cardiac catheterization and higher risk of major bleeding (when catheterization was performed) as compared to non-frail patients, thereby drawing attention to clinical strategies to avoid bleeding imperative in this population. Continue reading

N- acetylcysteine and Intravenous Sodium Bicarbonate Infusion in the Prevention of Contrast Associated Kidney Injury: A Cautionary Tale Strategies to Reduce Acute Kidney Injury and Improve Clinical Outcomes Following Percutaneous Coronary Intervention: A Subgroup Analysis of the PRESERVE Trial

A study published in JACC Cardiovascular Interventions has shown that among patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI), there was no benefit of IV sodium bicarbonate over IV sodium chloride or of acetylcysteine over placebo for the prevention of contrast-associated acute kidney injury (CAAKI) or intermediate-term adverse outcomes. Continue reading

Workplace Bullying and Violence Might be New, Potentially Modifiable Cardiovascular Risk Factors A multi-cohort study

A European study has revealed that bullying and violence are common at workplaces and those exposed to such stressors are at higher risk of cardiovascular disease (CVD). Psychosocial cardiovascular risk factors such as depression, subclinical depressive symptoms, vital exhaustion, anger, and personality traits such as hostility have been demonstrated as independent predictors of incident cardiovascular disease (CVD). Additionally, social factors associated with increased CVD risk include low socio-economic status, social isolation, low social support, and stress at work or in family life. Psychological and social factors are strongly inter-related and tend to cluster in certain individuals. In the recent most issue of the European Heart Journal, Xu et al. aimed to provide evidence for yet another psychosocial factor involved in CVD risk. Continue reading

Mechanistic Study Delves Into Heart Failure Benefits Noted With Empagliflozin EMPA-HEART Cardiolink-6 - EMPA-HEART

The EMPA-HEART trial showed that empagliflozin resulted in beneficial effects on left ventricular remodeling at 6 months among patients with type 2 diabetes mellitus and stable coronary artery disease (CAD) but normal ejection fraction and without a clear heart failure history. The findings were presented by Dr. Subodh Verma at the American Heart Association Annual Scientific Sessions (AHA 2018) in Chicago, Illinois. Continue reading

TRED-HF: Tread With Caution While Withdrawing Heart Failure Medication in Recovered Dilated Cardiomyopathy Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy: an open-label, pilot, randomised trial

The results of the TRED-HF trial published in The Lancet showed that withdrawal of heart failure medications among patients with dilated cardiomyopathy (DCM) who had recovered their LV function resulted in the relapse of HF. According to Halliday and his colleagues, until robust predictors of relapse are defined, treatment should continue indefinitely. Continue reading

Dapaglifozin ‘DECLARED’ Effective in the Reduction of Heart Failure Hospitalizations in Diabetic Population DECLARE-TIMI 58: Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes

The DECLARE–TIMI 58 trial, published in the New England Journal of Medicine and presented at AHA 2018 showed that in patients with type 2 diabetes who had or were at risk for atherosclerotic cardiovascular disease, treatment with dapagliflozin was non-inferior for reduction of MACE as compared to placebo but did result in a lower rate of cardiovascular death or hospitalization for heart failure. Continue reading

Fish Oil or Vitamin D Supplementation as Protection Against Cardiovascular Events or Cancer Suffers Deteriorating ‘VITAL’ Signs  AHA 2018: Vitamin D and Omega-3 Trial (VITAL)

The VITAL trial conducted by Manson et al. showed that supplementation with either n–3 fatty acids at a dose of 1 g/day or vitamin D3 at a dose of 2000 IU/day was not effective for primary prevention of cardiovascular or cancer events among healthy middle-aged men and women over 5 years of follow-up. The results were reported on Saturday at the American Heart Association Scientific Sessions meeting in Chicago and online in the New England Journal of Medicine. Continue reading

The Latest Incarnation of the Blood Cholesterol Management Guideline 2018: Numbers Matter, Lower LDL-C is better A Special Report From the American Heart Association and American College of Cardiology

The AHA/ACC 2018 guideline on the management of blood cholesterol, endorsed by at least 10 other medical societies, was published online in the Journal of the American College of Cardiology and in Circulation to coincide with its grand unveiling at the American Heart Association (AHA) Scientific Sessions 2018 in Chicago, Illinois.  Continue reading

Type 2 Diabetes: SGLT2 Inhibitors Demonstrate Robust Benefits on Cardiovascular and Renal Outcomes SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials

The results of a study presented at AHA 2018 have shown that SGLT2 inhibitors (SGLT2i ) have robust benefits on the reduction of hospitalization for heart failure (HF) and progression of renal disease regardless of existing atherosclerotic cardiovascular disease (ASCVD) or a history of HF. The findings were published online in The Lancet. Continue reading

Fish Oil Use in Hypertriglyceridemia Reduces Risk of Ischemic Events, Over-The-Counter Fish Oil Supplements Still ‘Fishy’ Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

 A study by Bhatt et al. published online in the New England Journal of Medicine, accompanied by a detailed supplement, was presented at AHA 2018 in Chicago, Illinois. The study demonstrated that among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly reduced among those who received 2 g of icosapent ethyl twice daily as compared with patients who received placebo. Continue reading