The results of the DECISION-CTO trial conducted by Lee et al. showcased that CTO-PCI was feasible with high success rates. In addition to this, there was no difference in the incidence of major adverse cardiovascular events with CTO PCI vs. no CTO-PCI, however, the study was limited by low power for clinical endpoints and high crossover rates between groups. The results were published online in Circulation. Continue reading →

The first nationwide comparison of the effectiveness and safety of warfarin and direct oral anticoagulants (DOACs) in a large atrial fibrillation (AF) cohort with data on low body weight (LBW) was conducted.  The findings, published in JACC, showed that DOACs are associated with a reduced risk of ischemic stroke, intracranial hemorrhage, hospitalization for gastrointestinal or major bleeds, all-cause death or the composite outcome in patients with LBW (<60kg).  A consistent trend was observed in patients with extremely LBW (<50kg), with the exception of hospitalization for gastrointestinal bleeding. Continue reading →

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 →

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 →

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 →

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 →

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 →

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 →

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 →

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 →

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 →

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 →

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; ClinicalTrials.gov: 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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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 →

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 →

An article by Sandhu et al. published in the American Heart Journal reported that on using critical access hospitals (CAHs) as a control group, the introduction of financial penalties was only associated with modest reductions in readmissions and an uncertain association with mortality. Continue reading →

Recently, Jérôme Wintzer-Wehekind M.D. and his team at Quebec Heart & Lung Institute, Laval University, Quebec, Canada conducted a vast cohort study published in the Journal of American College of Cardiology to look into the long-term outcomes (> 10 years) following PFO closure. Previous randomized trials conducted by various investigators had shown a marvelous reduction in ischemic stroke events for around 2-6 years post PFO closure but not many had gone beyond 10 years. The current study validated that device closure of PFO decreased recurrence of ischemic neurological events and continued to show similar results with the passage of time.  Continue reading →

A study published in JACC reported that fractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) datasets (FFRCT) had higher diagnostic performance as compared with standard coronary CTA, SPECT, and PET for vessel-specific ischemia, provided coronary CTA images were evaluable by FFRCT, whereas PET had a favorable performance in per-patient and intention-to-diagnose analysis. The investigators also stressed that in patients in whom 3-vessel FFRCT could be analyzed, FFRCT held the clinical potential to provide anatomic and hemodynamic significance of coronary lesions. Continue reading →

The FDA issued a Dear Doctor letter while investigating a potential safety signal with paclitaxel-coated balloons and stents used to treat peripheral artery disease. “This review will focus on the causes of death, the paclitaxel dose delivered, and patient characteristics that may impact clinical outcomes. Additional statistical analyses will be performed to clarify the presence and magnitude of any long-term risks,” the letter stated.  Continue reading →

A series of systematic reviews and meta-analyses have depicted how findings from prospective studies and clinical trials associated with relatively high intakes of dietary fiber and whole grains were complementary, and striking dose-response evidence indicated that the relationships to several non-communicable diseases could be causal. According to the publication in The Lancet, the implementation of recommendations to increase dietary fiber intake and to replace refined grains with whole grains is expected to benefit human health. Continue reading →