High-Sensitivity Troponin I Can Predict Mortality in Stable Patients Suspected to Have CAD The biomarker was more sensitive compared with other conventional troponin assays and predicted near-term MACE in low-risk patients.

Heightened levels of high sensitivity troponin I (hsTnI) can predict the near-term risk of death, acute myocardial infarction (MI), and hospitalization for unstable angina in stable symptomatic patients suspected to have coronary artery disease (CAD), according to a new study published in the Journal of American College of Cardiology. Continue reading →

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 →

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 →

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 →

Canakinumab: A New Hope for Post MI Patients with Increased hsCRP in the Prevention of Heart Failure The exploratory analysis of the CANTOS trial showed that canakinumab can decrease hear failure hospitalizations in ischemic patients in a dose-dependent manner

Canakinumab (an IL-B inhibitor) is associated with decreased heart failure (HF) hospitalizations and the composite of heart failure hospitalization and heart-failure related mortality in patients with a history of myocardial infarction (MI) and elevated high-sensitivity C-reactive protein (hsCRP), according to a new study published in Circulation. Continue reading →

Inducible Myocardial Ischemia May Be Excluded by Low Levels of High Sensitivity Cardiac Troponin Levels

In an original cohort study by Hammadah et al recently published in Annals of Internal Medicine, it has been found that very low high-sensitivity cardiac troponin(hs-cTn) levels can be used in the exclusion of inducible myocardial ischemia in patients with stable coronary artery disease (CAD). Moreover, it identifies people with CAD who have a lower risk of ischemia during stress testing and adverse cardiovascular events. Continue reading →

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.

Limitations

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).

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 →

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 →

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 →

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