Acute Coronary Syndrome
MR-INFORM: Myocardial Perfusion Based Strategy to Determine Need for Revascularization Shown to be Non-Inferior to Invasive Angiography in Reducing the Occurrence of Major Adverse Cardiovascular Events in Patients with Stable Angina
A trial led by Dr. Eike Nagel published in the New England Journal of Medicine showed that among patients with stable angina and risk factors for coronary artery disease, a myocardial-perfusion cardiovascular MRI based strategy to determine eligibility for revascularization was associated with a lower incidence of coronary revascularization than invasive angiography with fractional flow reserve (FFR) and was non-inferior to FFR in terms of the occurrence of major adverse cardiovascular outcomes.
Study Shows Noninvasive Hemodynamic Assessment Can Potentially Be Used To Identify Lesions At Risk of Progressing to Acute Coronary Syndrome
A study led by Dr. Joo Myung Lee showed that noninvasive hemodynamic assessment can be used to enhance the identification of high-risk plaques that could subsequently cause acute coronary syndrome (ACS). The study published in JACC: Cardiovascular Imaging suggests that noninvasive hemodynamic assessment could be integrated into the current standard of practice to potentially improve identification of a culprit lesion in future ACS.
Simulation Models Suggest Using Combination Drugs Is More Cost Effective Than Current Standard of Care in Patients with Cardiovascular Disease
Using microsimulation models, Dr. Thomas Gaziano showed that the use of a polypill has a favorable cost profile for secondary cardiovascular disease prevention in the United States. The findings of the study published in the American Heart Journal suggest that a polypill would be economically advantageous for both the patients and the payers.
Study Suggests That Higher Residual Inflammatory Risk Linked to Increased Rates of Ischemic Events in Patients Undergoing Percutaneous Coronary Intervention
A study led by Dr. Paul Guedeney that was published in the Journal of the American College of Cardiology showed that among patients undergoing percutaneous coronary intervention with an LDL of 70 mg/dl or less, a persistently high residual inflammatory risk is associated with an increased risk of major adverse cardiovascular and cerebrovascular events. Potentially targeting the increased residual inflammatory risk could improve outcomes in patients undergoing percutaneous coronary intervention (PCI).
Study Shows An Increase in the Levels of Hepatocyte Growth Factors Associated with a Higher Risk of Cardiovascular Disease
A study led by Paul Decker showed that changes in the levels of hepatocyte growth factor (HGF) were an independent predictor of the incidence of coronary heart disease. The findings of this research letter published in the American Heart Journal could help understand the role of HGF in coronary heart disease.
New Study Involving 95,000 Stents Shows Outcomes of Bioabsorbable Polymer Drug-Eluting Stents Not Better than Permanent Drug-Eluting Stents in Reducing Stent Thrombosis and Restenosis
In a study published in the European Heart Journal, Dr. Sergio Buccheri showed that patients with bioabsorbable polymer drug-eluting stents (BP-DES) did not have a better outcome when compared to patients who receive permanent polymers (PP-DES) during percutaneous coronary intervention (PCI).
COMPASS: Treatment Benefit of Combined Low Dose Rivaroxaban and Aspirin Preserved in Patients with Moderate Renal Impairment
A secondary analysis of the COMPASS trial showed that the benefit of combining rivaroxaban 2.5mg twice daily and aspirin is preserved in patients with moderate renal dysfunction. Dr. Keith A.A. Fox demonstrated in the study published in the Journal of the American College of Cardiology that these patients did not have an excess risk of bleeding.
Cohort Study Shows That a New HDL Apolipoproteomic Score Correlates with Both Risk of Coronary Artery Disease and Risk of Cardiovascular Death
In a study led by Dr. Pradeep Natarajan showed that an HDL apolipoproteomic score is associated with coronary artery disease (CAD). Additionally, the study published in the Journal of the American College of Cardiology showed that among individuals with CAD, this score is independently associated with cardiovascular death.
Study Shows Inconsistency in Identifying the Infarct Related Artery by Angiography When Compared to Cardiac Magnetic Resonance Imaging
A new study led by Dr. John Heitner, published in Circulation: Cardiovascular Interventions, suggests that Delayed-enhancement cardiac magnetic resonance (DE-CMR) can be helpful in identifying the infarct-related artery (IRA) in patients with non-ST elevation myocardial infarction (NSTEMI). This could help interventional cardiologists decide on the coronary vessel that would need treatments.
Study Suggests ICU Care May Be Overutilized in Stable STEMI Patients
A study led by Dr. Jay S. Shavadia published in JACC: Cardiovascular Interventions showed that although more than 80% of stable patients with an ST-elevation myocardial infarction (STEMI) were treated in the intensive care unit (ICU), the risk of developing a complication requiring ICU care was around 16%. These findings suggest that implementing a risk-based triage strategy could be a better alternative to the current strategy where patients with STEMI are typically admitted to the ICU.
AHA Releases a Scientific Statement Regarding Patients with Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease
The American Heart Association (AHA) released a scientific statement that aims to provide a formal and updated definition for Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA). It also outlines a useful framework for the diagnostic approach and management of patients with potential MINOCA.
STOPDAPT-2 Explores Safety and Efficacy of 1-month DAPT Followed by Clopidogrel Monotherapy vs Standard 12-month DAPT After Drug-Eluting Stent Implantation
The results of the STOP-DAPT 2 randomized controlled trial were presented by Dr. Hirotoshi Watanabe at the American College of Cardiology Annual Scientific Session (ACC 2019), at New Orleans, LA. According to the findings, 1-month DAPT was superior to 12-month DAPT in the prevention of net adverse ischemic events. Continue reading
AUGUSTUS: Less Bleeding and Fewer Hospitalizations Without Significant Differences in Ischemic Events With Apixaban and No Aspirin in Patients With AFib and ACS ACC 2019: Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation
ACC 2019: In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both, according to results of the AUGUSTUS trial presented at ACC.19 in New Orleans. The results were also published simultaneously in the New England Journal of Medicine. 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
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
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.
Administration of Cangrelor In Addition to Crushed Ticagrelor Bridges Gap of Antiplatelet Inhibition in Patients Undergoing Primary PCI Results from the CANTIC study
According to a new study, Cangrelor could serve to bridge the gap of antiplatelet inhibition in patients undergoing primary percutaneous coronary intervention (P-PCI) for acute coronary syndrome, who were administered crushed ticagrelor. Additionally, no drug-drug interactions (DDI) were reported between the two P2Y12 inhibitors, based on the findings published in Circulation. Continue reading
Adjunctive Low Dose Alteplase During Primary PCI Fails to Imrpove Microvascular Obstruction in STEMI Patients Results of the T-Time trial presented at the American Heart Association (AHA) 2018 Scientific Sessions
A multi-center randomized, double blind, placebo-controlled, parallel group clinical trial has shown that among patients with acute ST-elevation myocardial infarction (STEMI) presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given after reperfusion via primary percutaneous intervention does not reduce microvascular obstruction. Continue reading
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
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
