0/1hr or 0/3hr hsTroponin T in Suspected ACS?

Key Points:

  • Among patients with suspected acute coronary syndromes (ACS) and ischemia excluded on an initial electrocardiogram, randomized allocation of unmasked hs-cTnT within a 0/1-hour protocol as opposed to a 0/3-hour protocol with troponin T results masked at <29 ng/L was associated with:
    • Reduction in functional stress testing
    • Increase in coronary angiography and revascularization
  • Unmasked reporting of hs-cTnT was not associated with a reduction in late death or myocardial infarction (MI) over 12 months of follow up
  • Among those presenting with troponins within the masked range (≤29 ng/L), a significant increase in death or MI emerged within 12 months of follow up

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Low Dose Atorvastatin Did Not Reduce Composite Endpoint in Patients with COVID-19

INSPIRATION-S led by Behnood Bikdeli, MD, MS, and presented at the American College of Cardiology 2021 Meeting, failed to show the efficacy of atorvastatin in reducing thrombotic events and all-cause mortality.  According to the presenter, the subgroup analysis demonstrated some hypothesis-generating signals that need to be further investigated in future research.

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ACTION-Coalition Trial: Therapeutic Dose of Anticoagulation Is Associated With Increased Risk of Bleeding and No Improvement in Clinical Outcomes Among Hospitalized COVID-19 Patients With Elevated D-Dimer Levels

ACTION presented at the American College of Cardiology 2021 meeting by Renato D. Lopes, MD, PhD, demonstrated that among patients hospitalized with COVID-19 and elevated D-dimer levels, therapeutic anticoagulation with full-dose anticoagulant did not improve clinical outcomes and increased bleeding compared with prophylactic dose anticoagulation. Continue reading

Paclitaxel-Coated Devices Not Associated with Higher Mortality, Results from SAFE-PAD Show

Paclitaxel-coated balloons had come under fire in recent years, after a meta-analysis of randomized control trials involving their use for the treatment of peripheral artery disease found an associated with higher mortality when compared to non-drug coated devices. The study led to a letter of caution published by the FDA, leading to hesitance on the part of both physicians and patients to use the devices ever since. In June of 2019, the FDA called for additional long-term safety data to allow Paclitaxel-coated balloons to remain on the market. Continue reading

No benefit to FFR-guided PCI over angiographic-guided PCI of Nonculprit Lesions after STEMI: Results from FLOWER-MI Show

Key Points:

  • While FFR-guided PCI is superior in chronic coronary syndrome, its role in primary PCI of acute coronary syndrome remained unknown.
  • Patients with STEMI and multivessel disease, were randomized to undergo FFR-guided PCI versus angiography-guided PCI of non-culprit lesions after treatment of the culprit.
  • There was no difference in MACE at one year between the two intervention arms at one year.

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Aspirin Vs. Clopidogrel During Chronic Maintenance Monotherapy After Percutaneous Coronary Intervention: The Host Exam Randomized Controlled Trial


  • Clopidogrel is superior to aspirin as chronic maintenance therapy after drug eluting stent (DES) placement with contemporary percutaneous coronary intervention (PCI) following 12 ± 6 months of dual antiplatelet therapy (DAPT)
  • Specifically, those on Clopidogrel had a reduction in the composite endpoint of myocardial infarction, stroke, readmission for ACS as well was the secondary endpoints of thrombotic and bleeding events

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Additional background and insight

Presented by Dr. Schuyler Jones, assistant professor of medicine, Duke University, and a member of the Duke Clinical Research Institute in the first Late Breaking Clinical Trial session, “Aspirin Dosing: A patient-centric Trial Assessing the Benefits and Long-term Effectiveness (ADAPTABLE)” asked a key question that many patients and physicians, PAs, and NPs face every day: Is 81 mg or 325 mg of aspirin more effective for secondary prevention for patients with pre-existing or established cardiovascular disease?

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REHAB-HF: A Novel Physical Rehabilitation Intervention For Older Patients With ADHF

Key Points:

  • Elderly frail patients with acute decompensated heart failure hospitalizations benefit from cardiac rehabilitation
  • Tailored rehabilitation led to a large, significant improvement in Short Physical Performance Battery (SPPB) score which was relatively uniform across pre-specified subgroups
  • Rehabilitation intervention patients saw large, significant, clinically meaningful improvements in 6-minute walk distance, quality-of-life, Fried Frailty score, and depression

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DAPT with Clopidogrel Superior to Ticagrelor one month after PCI: Results from the TALOS-AMI Trial

With the widespread use of second-generation drug eluting stents, it has become more apparent that the risk of stent thrombosis decreases significantly after the first thirty days. The risk of bleeding, on the other hand, increases during that same time period. It has been proposed that de-escalation of potent P2Y12 inhibitors could mitigate that risk of bleeding. Dr. Kiyuk Chang and his co-investigators sought to answer this in the TALOS-AMI trial, the results of which were presented during a late breaking clinical trial session today at the 2021 American College of Cardiology Scientific Sessions. Continue reading

Ultrasound Guided Renal Denervation shown to Decrease Ambulatory Blood Pressure in Patients with Resistant Hypertension: Results from the RADIANCE-HTN TRIO Trial

While renal denervation has been shown to improve blood pressure in patients with moderate hypertension, its effects on resistant hypertension have been more modest. During Sunday’s Late Breaking Clinical Trials session of the American College of Cardiology’s 2021 Scientific Sessions, Dr. Ajay Kirtane of Columbia University, presented the findings of the anticipated RADIANCE-HTN TRIO Trial, seeking to shine a light on the previously nebulous data. Continue reading

Relationship Between Omega-3 Fatty Acid Levels And Major Adverse Cardiovascular Outcomes In Patients With High Cardiovascular Risk


  • There is not enough evidence to state whether Omega-3 Fatty Acid levels are beneficial or harmful against major adverse cardiovascular events in patients with high cardiovascular risk.

Dr. Steven E. Nissen is the chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic and Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.  Prior to summarizing Dr. Nissen’s late breaking trial at presented May 16, Day 2 of ACC 2021 that is concurrently published in JAMA Cardiology . Continue reading

Are ACE Inhibitors or Beta-Blockers Cardioprotective During Adjuvant Treatment for Early-Stage Breast Cancer?

New results were presented from the Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA) trial at ACC 2021 on May 16 and published concurrently in Circulation .  The authors found that medications administered in addition to surgery, adjuvant breast cancer (BC) therapy with anthracylines with or without anti-human epidermal growth factor receptor 2 (HER2) therapy, and radiotherapy may not significantly attenuate the reduction in left ventricular ejection fraction (LVEF), nor improve cardiac troponins in early-stage BC patients.
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PRADA: Cardioprotective Agents May Not Be Required During Breast Cancer Tx

Adjuvant breast cancer therapy, while beneficial in prolonging survival, has been shown to have harmful effects on the heart, prompting some providers to prescribe neurohormonal blocking agents to attenuate the myocardial damage. The original PRADA trial showed that candesartan and metoprolol helped prevent a decline in LVEF in patients on adjuvant therapy. To date, however, smaller studies have not shown a similar benefit to neurohormonal blockade. In a late breaking clinical trial session on May 16 at the 2021 American College of Cardiology Scientific Sessions meeting, Dr. Siri Lagethon Heck of Akershush University Hospital in Oslo, Norway, presented the long-term follow up results of the PRADA trial. Continue reading

TWILIGHT: Analysis Shows Sex Disparities in PCI Outcomes Still Exist

Women fared worse than men in terms of increased bleeding risk, but comparable to men for ischemic event rates, results of a subgroup analysis of the TWILIGHT study presented May 15 at the 70th annual meeting of the American College of Cardiology (ACC) found. However, benefits of early aspirin withdrawal and continued use of ticagrelor in this high-risk PCI population was found to be comparable between sexes. Continue reading

Rivaroxaban shown to lower future vascular events after peripheral revascularization: results from VOYAGER-PAD

Rivaroxaban should be considered as adjunctive therapy to aspirin alone in patients undergoing peripheral limb revascularization, authors of the VOYAGER-PAD trial concluded today. In the Late Breaking Clinical Trials session earlier today at the 2021 American College of Cardiology Scientific Sessions, Dr. Rupert Bauersachs of Darmstadt, Germany, presented the anticipated results of the trial, which attempted to answer whether post-intervention rivaroxaban could prevent future limb ischemia and need for repeat revascularization.

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Dapagliflozin in the Treatment of COVID-19: Insights from the DARE-19 Trial

SGLT-2 inhibitors have demonstrated efficacy in various cardiometabolic conditions, including heart failure, coronary artery disease, chronic kidney disease, and diabetes. Given its favorable profile in various disease states, and the lack of effective therapies for patients hospitalized with COVID-19, it was hypothesized that dapagliflozin could provide organ protection in patients with cardiometabolic risk factors and COVID-19. During today’s Late Breaking Clinical Trials Session at the American College of Cardiology 2021 Scientific Sessions meeting, Dr. Mikhail Kosiborod of Saint Luke’s Mid Americas Hospital system presenting the findings of DARE-19, Dapagliflozin in Respiratory Failure in patients with COVID-19.

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Tricuspid Valve Replacement with the Transcatheter Evoque Valve is Safe and Effective at 30 days

Transcatheter tricuspid valve replacement has become a feasible alternative to surgery in patients deemed to be at high risk of adverse events, and in the past decade, various devices have been designed to meet this clinical need. In his Focused Clinical Research session on the opening day of the American College of Cardiology 2021 Scientific Sessions, Dr. Susheel Kodali, director of the Structural Heart & Valve Center at New York-Presbyterian/ Columbia University Medical Center presented the 30-day results from the implantation of the EVOQUE valve, as part of the TRISCEND study. Continue reading

Real-World Data Supports Continued use of Transcatheter Left Atrial Appendage Occlusion

The WATCHMAN left atrial appendage occluder device has been widely accepted as an alternative to oral anticoagulation for stroke prevention in patients with underlying atrial fibrillation. However, the indications for WATCHMAN implantation laid forth by the Centers for Medicare & Medicaid Services in the United States differ from the original trials supporting its use. Real-world practice, therefore, highlights significant differences in the characteristics of patients receiving the therapy from those originally studied.  In a Focused Clinical Research Session at the 2021 American College of Cardiology meeting, Dr. Matthew Price, Director of the Cardiac Cath Lab at Scripps Green Hospital and Assistant Professor at the Scripps Translational Science Institute, La Jolla, California, presented the results of his study from the NCDR LAAO Registry (NCT02699957), assessing one- year real-world outcomes for patients undergoing WATCHMAN implantation.

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Apixaban Associated with Fewer Subclinical Valve Thrombosis Events: Results from the ATLANTIS 4D-CT Substudy

Subclinical valve thrombosis after transcatheter aortic valve intervention (TAVI) has emerged as a challenge to the standardization of antithrombotic therapy after valve implantation. Results of the randomized ATLANTIS trial, presented also today, May 15, as a Late Breaking Clinical Trial at ACC 2021, showed no superiority of apixaban over standard of care after transcatheter aortic valve intervention, irrespective of the baseline need for anticoagulants. In his Focused Clinical Research Session, Gilles Montalescot, MD, PhD, Professor of Cardiology at the Pitié-Salpêtrière Hospital, Paris, presented the 4D-CT substudy results to assess the incidence and implications of CT-proven valve thrombosis. Continue reading

Apixaban not Superior to Standard of Care after TAVR in ATLANTIS

The administration of apixaban monotherapy after transcatheter aortic valve replacement is not superior to the standard of the care antithrombotic treatment, results of the randomized, phase IIIb, prospective, open label, ATLANTIS trial, Anti-Thrombotic Strategy After Trans-Aortic Valve Implantation for Aortic Stenosis (NCT02664649), show. These findings hold true regardless of a patient’s baseline requirement for anticoagulation. Continue reading