According to the results of the TREAT trial, among patients aged under 75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events in comparison with clopidogrel. The results of the 12-month analysis were recently published in the Journal of the American College of Cardiology. Continue reading →

The total event analysis from the REDUCE-IT trial, presented at ACC 2019 showed that among statin-treated patients with elevated triglycerides and cardiovascular disease or diabetes, icosapent ethyl substantially reduced the burden of first, subsequent, and total ischemic events. The results are exciting as this is one of the first non-LDL targeted trials to demonstrate a cardiovascular benefit, and is likely to be featured in future guidelines. Continue reading →

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 →

The largest LVAD trial ever to be performed, led by Dr. Mandeep Mehra published the final analysis of a fully magnetically levitated left ventricular assist device in the New England Journal of Medicine. According to this, among patients with advanced heart failure, a fully magnetically levitated centrifugal- flow pump has been found to be superior to a mechanical-bearing axial-flow pump in advanced heart failure patients in terms of survival free of disabling stroke or reoperation for removal in case of device malfunction. Continue reading →

NEW ORLEANS — Transcatheter repair of functional mitral regurgitation (or secondary MR) with MitraClip improved quality of life and hemodynamics better than optimal medical therapy alone, COAPT trial analyses showed. Indeed, the COAPT QOL study showed that among patients with symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated medical therapy, edge-to-edge TMVr resulted in substantial early and sustained health status improvement compared with medical therapy alone. Continue reading →

The design of the HEARTLINE randomized trial of up to 180,000 pts for assessing the efficacy of the Apple Watch & educational initiatives to reduce a composite outcome of death, MI and stroke was presented by Dr. C. Michael Gibson, PERFUSE Study Group, Beth Israel Deaconess Medical Center, Boston, Massachusetts, at ACC 2019, in New Orleans,  LA earlier today. The HEARTLINE Study brings together Johnson & Johnson’s health and behavioral science expertise and long heritage in treating cardiovascular disease with Apple’s technology expertise. Emerging technology holds great potential to help identify people at risk for future disease and develop interventions to prevent disease before it occurs. Leveraging a new heart health app from Johnson & Johnson in combination with Apple Watch’s irregular rhythm notifications and ECG app, the HEARTLINE Study will seek to investigate whether this technology can accelerate the diagnosis of AFib and improve outcomes including the prevention of stroke, as well as assess the impact of a medication adherence program. The study will be conducted in the U.S. only and will be designed as a pragmatic randomized controlled research study for individuals age 65 years or older. Continue reading →

The results of a trial presented by Dr. Adam DeVore at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, reflected that among patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated heart failure, the initiation of sacubitril–valsartan therapy led to a greater reduction in the NT-proBNP concentration as compared with enalapril therapy. In addition to this, the rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two arms. Continue reading →

According to an observational study posted in the Journal of American Heart Association, there were strong associations between social factors and mortality risk after CABG in both men and women. These results emphasized the importance of developing and implementing secondary prevention strategies for socially disadvantaged CABG patients. Continue reading →

In an analysis of two randomized clinical trials published in JAMA cardiology, Fournier et al. reported that the larger the improvement in FFR, the larger the symptomatic relief and the lower the event rate. This was suggestive of the fact that measuring FFR before and after PCI could provide clinically useful information. Continue reading →

According to a randomized controlled trial led by Dr. Michael Gibson, PERFUSE Study Group, Beth Israel Deaconess Medical Center, Boston, Massachusetts, the implantable cardiac system was found to detect early ST-segment deviation and alert patients of a potential occlusive event. Although the trial did not meet its pre-specified primary efficacy endpoint, the report published in the Journal of the American College of Cardiology provided evidence that the device was beneficial among high-risk subjects in the identification of asymptomatic events. Continue reading →

The US food and drug Administration (FDA) has recently been conducting an investigation on voluntary recalls of multiple generic angiotensin II receptor blocker (ARB) drug products used to treat high blood pressure and heart failure. The recalls initiated in July 2018 and continue to date due to the presence of Nitrosamine impurities, including N-Nitrosodimethylamine (NDMA) and N-Nitrosodiethylamine (NDEA), which are potential human carcinogens in different ARB products. Last week, AurobindoPharma USA notified that it is expanding its recall to include 38 more lots of valsartan and amlodipine/valsartan tablets due to objectionable levels of N-Nitrosodiethylamine (NDEA). This was later followed by an expanded voluntary recall of losartan potassium produced by Hetero Labs (India) when they were found to be contaminated by N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). Camber Pharmaceuticals called back 87 lots of losartan potassium tablets (25 mg, 50 mg and 100 mg), 114 lots of losartan potassium or losartan potassium/hydrochlorothiazide tablets, and one lot of losartan potassium/hydrochlorothiazide tablets. Continue reading →

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 →