Should Patients with Acute Chest Pain Undergo Noninvasive Testing After the Clinical Diagnosis is Made?

The use of noninvasive cardiac tests such as coronary computed tomographic angiography (CCTA) or stress testing for patients presenting to the emergency department with chest pain is not associated with a better clinical outcome when compared to the conventional method for diagnosing acute coronary syndrome, according to a recent study published in the Journal of American Medical Association. Continue reading

Is Sodium Bicarbonate or N-Acetyl-Cysteine Effective in Preventing Contrast-Induced Nephropathy?

In a recent study published in the New England Journal of Medicine, it was found that amongst patients undergoing angiography, sodium bicarbonate is not better than sodium chloride  and neither is acetylcysteine better than oral placebo in the prevention of a composite outcome of death, need for dialysis, or persistent kidney injury. The treatment was also ineffective in reducing the risk of contrast-associated acute kidney injury.

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CABG Versus PCI in Multivessel Disease

In a recent study published in The Lancet, it was found that there is a mortality benefit for patients with multivessel disease undergoing CABG compared to PCI. However, the reduction in mortality was not statistically significant in patients with only left main artery disease. With recent advancements in stenting techniques, the benefit of using CABG over PCI has been debatable. Prior to this , no study was powered to compare the mortality benefits between these interventions.

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Andexanet alfa: Rapid reversal of Factor Xa inhibitors

On Monday, March 12th at ACC 2018 in Orlando, Florida, an interim analysis from the ongoing ANNEXA-4 study demonstrated that the first- in-class reversal drug for direct and indirect factor Xa inhibitors, Andexanet alfa, was able to effectively reverse the anti-factor Xa activity and control major bleeding events among patients taking one of four Factor Xa inhibitors (apixaban, rivaroxaban, edoxaban or enoxaparin). Continue reading

Using High Sensitivity Troponin T in Ruling Out Acute Coronary Syndrome

High sensitivity troponin T (hsTnT) can be a reliable tool for excluding acute coronary syndrome (ACS) in very low-risk patients, according to a recent study published in the Journal of American Medical Association. Continue reading

ODYSSEY Demonstrates a Mortality Benefit in ACS Patients

Results of the much anticipated ODYSSEY Outcomes trial were presented today by Professor Phillipe Gabriel Steg, who is the chief of cardiology at Bichat-Claude Bernard Hospital, at the American College of Cardiology (ACC) Scientific Sessions in Orlando. Alirocumab, a monoclonal antibody directed against PCSK9, reduced major adverse cardiovascular events (MACE), myocardial infarction (MI), ischemic stroke and all-cause mortality in patients post-acute coronary syndrome (ACS), who were on high-intensity statin therapy. Continue reading

AHA Releases a Scientific Statement for Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) has gained considerable recognition as an important cause of acute myocardial infarction (AMI), particularly among young females without conventional cardiovascular risk factors.  To facilitate dissemination of current knowledge on SCAD, a Scientific Statement from the American Heart Association was recently published in Circulation by Hayes et al. concerning the current knowledge of epidemiology, precipitants and triggers, pathophysiology, and associated comorbidities.  Furthermore, the document provides an overview of the advance in diagnostic imaging, management options, as well as the prognostic outlook for SCAD, in hopes of spurring a paradigm shift in the care of this under-diagnosed condition. Continue reading

Does Magnitude of CRP Level Reduction Correlate With Cardiovascular Mortality?

In a recent study published in The Lancet, it has been found that the magnitude of reduction in C Reactive Protein (CRP) levels due to treatment with Canakinumab, an interleukin 1β targeting monoclonal antibody, may directly correlate with a decrease in major cardiovascular events in post-myocardial infarction (MI) patients, even in the absence of an alteration in LDL levels. Continue reading

Thrombectomy Done Beyond 6 Hours has a Favorable Prognosis in Stroke Patients

In a recent study published in the New England Journal of Medicine, it was found that endovascular thrombectomy for ischemic stroke that is performed 6 to 16 hours after the onset of symptoms resulted in better functional outcomes than standard medical therapy alone among patients with a proximal middle cerebral artery or internal carotid artery occlusion. Continue reading

Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection

In a recent retrospective cohort study published in the New England Journal Medicine, a significant association was found between acute respiratory infections, particularly influenza, and the occurrence of acute myocardial infarction (MI) in the following week. The study also highlights the increased risk in older patients and in those who are hospitalized for the first time for an MI. Continue reading

S-LAAO Reduces Thromboembolism in AFib Patients After Heart Surgery

In a recent retrospective cohort study published in the Journal of American Medical Association conducted on patients with atrial fibrillation (AF) undergoing cardiac surgery, surgical left atrial appendage occlusion (S-LAAO) as compared with no surgical left atrial appendage occlusion (no S-LAAO) was significantly associated with lower risk of readmission for thromboembolism.  Continue reading

D-dimer Level is Associated With Increased Long-term Cancer Incidence and All-cause Mortality

According to a recently published article in Circulation, it was found that D-dimer level is an independent predictor of the long-term (up to 16 years) risk of arterial and venous events, cause-specific mortality, and the incidence of new cancers. The results of the study are based on a  subanalysis of the LIPID trial. Continue reading

Does Marijuana Use Impact Cardiovascular Health?

With the increasing use and the legalization of marijuana in several states of USA, there is a need to evaluate its impact on the health. To explore this, a systematic review was recently published in Annals of Internal Medicine by Ravi et al. In the study, the investigators studied the association between marijuana use and cardiovascular outcomes. The authors concluded, “Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient”. Continue reading

Can CTCA-derived Plaque Characteristics Predict MACE?

A systematic review and meta-analysis recently published in the journal, Circulation, showed a strong association between computed tomographic coronary angiography (CTCA) defined high risk plaque (HRP) features and major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD). Continue reading

Gender Differences in Outcomes With TAVR Women Undergoing TAVR are at a Decreased Risk of Long-term Mortality

In a recent meta-analysis published in the Journal of the American College of Cardiology, it was found that postoperative complications of Transcatheter Aortic Valve Replacement (TAVR) were different between males and females. While females were at increased risk of short-term complications (within 30 days) such as bleeding, stroke, and vascular complications, they had a lower incidence all-cause mortality within one year of the procedure. Continue reading

Mechanically Expanded vs Self-Expanding TAVR in AS Mechanically Expanded Valves May be a Useful Addition for TAVR

The use of mechanically expandable valves was not inferior to self-expandable valves in high risk patients with severe aortic stenosis enrolled in the REPRISE III clinical trial. The trial results support the potential for the first generation LOTUS valve to become part of regular clinical practice. Continue reading

Silent MI: A Risk Factor for Heart Failure? Link between silent myocardial infarction and heart failure

In a recent analysis published in the Journal of the American College of Cardiology, a link between silent myocardial infarction and subsequent heart failure has been demonstrated, revealing a novel potential marker for heart failure. Continue reading

Novel Echo Markers In Stroke Risk Stratification In AFib

The assessment of left atrial reservoir strain and P-wave to A’ duration on tissue Doppler imaging provides additional risk stratification for stroke after initial CHA2DS2-VASc scoring, according to a study published in the European Heart Journal, and may prove helpful in guiding decisions about anticoagulation for patients after the diagnosis of atrial fibrillation. Continue reading

MRI Safe in Patients with Legacy Cardiac Devices

The use of MRI resulted in no long-term clinically significant adverse events in patients with legacy cardiac devices and only 1 in 200 patients experienced a power-on reset of the cardiac device, according to a recent publication in the New England Journal of Medicine. Continue reading

Mortality in PCI Patients With Incomplete Revascularization

In a recent retrospective observational study published in JAMA Cardiology, patients that underwent percutaneous coronary interventions with incomplete revascularization were at higher risk of mortality if they had at least 90% stenosis in an incompletely revascularized vessel, incomplete revascularization in 2 or more vessels, or proximal left anterior descending artery incomplete revascularization. Continue reading