Open access
Open access
Powered by Google Translator Translator

Coronary Insufficiency

Cohort Study: Late ventricular arrhythmias are rare in STEMI patients without left ventricular dysfunction post-primary PCI – JAMA Netw Open

11 May, 2024 | 14:15h | UTC

Study Design and Population: This cohort study analyzed data from the US National Cardiovascular Data Registry Chest Pain–MI Registry, involving 174,126 adults with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) from 2015 to 2018. The population included a broad demographic with a focus on those experiencing late ventricular tachycardia (VT) or ventricular fibrillation (VF) post-PCI, specifically examining occurrences one day or more after the intervention.

Main Findings: The study found that 8.9% of the patients developed VT or VF after PCI, with 2.4% experiencing these arrhythmias late in the hospitalization period. Among patients with uncomplicated STEMI, late VT or VF with cardiac arrest was exceedingly rare, occurring in only 0.1%. Notably, reduced left ventricular ejection fraction was strongly associated with an increased risk of late VT or VF with cardiac arrest. The presence of late VT or VF significantly correlated with higher in-hospital mortality rates.

Implications for Practice: The findings suggest that late VT or VF after primary PCI in STEMI patients is infrequent, particularly among those without complications. This data supports the potential for safe earlier hospital discharge in uncomplicated cases. However, vigilance is advised due to the significant mortality risk associated with late VT or VF events. Clinicians should consider patient-specific risk factors such as left ventricular function when making discharge decisions.

 

Reference (link to free full-text):

Rymer JA et al. (2024). Ventricular Arrhythmias After Primary Percutaneous Coronary Intervention for STEMI. JAMA Network Open, 7(5), e2410288. DOI: 10.1001/jamanetworkopen.2024.10288.

 

RCT: Beta-blockers post myocardial infarction showed no benefit in patients with preserved ejection fraction

30 Apr, 2024 | 13:40h | UTC

This randomized, open-label clinical trial conducted across 45 centers in Sweden, Estonia, and New Zealand examined the impact of long-term beta-blocker treatment in patients with acute myocardial infarction (AMI) who had undergone coronary angiography and had a preserved left ventricular ejection fraction (LVEF ≥ 50%). The study involved 5020 patients, predominantly from Sweden, with a median follow-up of 3.5 years. Participants were randomly assigned to receive either a beta-blocker (metoprolol or bisoprolol) or no beta-blocker. The primary endpoint was a composite of death from any cause or new myocardial infarction. The results showed no significant difference in the primary endpoint between the beta-blocker group (7.9%) and the no–beta-blocker group (8.3%) with a hazard ratio of 0.96 (95% CI, 0.79 to 1.16; P=0.64). Additionally, no significant differences were observed in secondary endpoints such as death from cardiovascular causes, myocardial infarction, or hospitalizations for atrial fibrillation and heart failure. Safety endpoints were also comparable between the groups. Overall, long-term beta-blocker treatment did not confer a reduction in risk for the primary composite endpoint or improve secondary outcomes in this patient population.

 

Commentary on X:

 

Reference (link to abstract – $ for full-text):

Troels Yndigegn et al. (2024). Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med, 390(15), 1372-1381. DOI: 10.1056/NEJMoa2401479.

 

RCT: Post-1 month ticagrelor monotherapy vs. dual antiplatelet therapy significantly reduces bleeding events in acute coronary syndromes

30 Apr, 2024 | 13:26h | UTC

In this randomized, placebo-controlled, double-blind clinical trial, 3400 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) were assessed to compare the effects of ticagrelor alone versus ticagrelor plus aspirin from 1 to 12 months post-PCI. The study aimed to determine if ticagrelor alone could reduce bleeding without increasing major adverse cardiovascular or cerebrovascular events (MACCE). The primary findings indicated that ticagrelor alone resulted in significantly lower clinically relevant bleeding (2.1% vs. 4.6%, p<0.0001) and demonstrated non-inferiority in MACCE rates compared to the dual therapy group (3.6% vs. 3.7%, pnon-inferiority<0.0001). These outcomes suggest that ticagrelor monotherapy, starting one month post-PCI, may be an effective alternative to standard dual antiplatelet therapy in reducing bleeding risks without compromising safety.

 

Commentary on X:

 

Reference (link to abstract – $ for full-text):

Ge Z. et al. (2024). Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. The Lancet, 404(10102), 1173-1182. DOI: https://doi.org/10.1016/S0140-6736(24)00473-2.

 

RCT: Efficacy and safety of microaxial flow pump in STEMI-related cardiogenic shock

28 Apr, 2024 | 20:17h | UTC

This randomized clinical trial assessed the impact of a microaxial flow pump (Impella CP) on mortality in 355 patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Patients were randomly assigned to receive either the microaxial flow pump plus standard care or standard care alone. The primary outcome was mortality at 180 days. Results showed a significant reduction in death rates in the microaxial flow pump group (45.8%) compared to the standard care group (58.5%) with a hazard ratio of 0.74 (95% CI, 0.55 to 0.99; P=0.04). However, the incidence of severe adverse events was notably higher in the microaxial flow pump group, including severe bleeding and device-related complications.

 

Reference (link to abstract – $ for full-text):

Jacob E. Møller et al. (2024). Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med, 390(15), 1382-1393. DOI: 10.1056/NEJMoa2312572

 

RCT: Reduction in cardiac events through preventive PCI in vulnerable atherosclerotic coronary plaques

28 Apr, 2024 | 17:39h | UTC

This multicenter, open-label, randomized controlled trial assessed the effectiveness of preventive percutaneous coronary intervention (PCI) versus optimal medical therapy alone in treating patients with non-flow-limiting vulnerable coronary plaques identified by intracoronary imaging. Conducted across 15 research hospitals in four countries, the trial enrolled 1,606 patients, with 803 in each treatment group. After 2 years, major adverse cardiac events were significantly lower in the PCI group (0.4%) compared to the medical therapy group (3.4%), with a p-value of 0.0003. These results suggest that preventive PCI can effectively reduce cardiac events in patients with high-risk vulnerable plaques, supporting the expansion of PCI indications to these patients.

 

Reference (link to abstract – $ for full-text):

Prof Seung-Jung Park et al. (2024). Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial. The Lancet, Volume Not Specified (Issue Not Specified), Pages Not Specified. DOI: https://doi.org/10.1016/S0140-6736(24)00413-6

 

RCT: Intravascular ultrasound guidance improves outcomes in percutaneous coronary intervention for acute coronary syndrome

28 Apr, 2024 | 17:22h | UTC

This randomized clinical trial evaluated 3505 acute coronary syndrome (ACS) patients across 58 centers in China, Italy, Pakistan, and the UK, comparing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI. The study’s primary endpoint was target vessel failure—comprising cardiac death, myocardial infarction, or revascularisation—after 1 year. The IVUS-guided group showed significantly lower rates of the primary endpoint (4.0%) compared to the angiography-guided group (7.3%), with a hazard ratio of 0.55. This outcome was primarily driven by reductions in myocardial infarction and revascularisation, with similar safety profiles between the two groups.

 

Reference (link to abstract – $ for full-text):

Xiaobo Li et al. (2024). Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. The Lancet, Volume (Issue), Pages. DOI: https://doi.org/10.1016/S0140-6736(24)00282-4

 

M-A Proportional increase in new-onset diabetes with different intensities of statin therapy

27 Apr, 2024 | 15:41h | UTC

Study Design and Population:

This research is a meta-analysis of individual participant data from large, long-term, randomized, double-blind controlled trials involving statins. The study encompasses 19 trials comparing statin use to placebo and four trials comparing varying intensities of statin therapy, involving a total of 154,664 participants over periods ranging from 4.3 to 4.9 years. Participants were adults enrolled in statin trials with a scheduled duration of at least two years and a participant count of at least 1000.

 

Main Findings:

The study revealed a dose-dependent increase in the incidence of new-onset diabetes when using statins. Participants receiving low to moderate-intensity statin therapy showed a 10% increase in new-onset diabetes annually compared to placebo, while those on high-intensity statin therapy exhibited a 36% increase. The absolute increases in new-onset diabetes were significantly influenced by the extent of HbA1c measurement. Notably, a large portion of new-onset diabetes cases occurred among participants with baseline glycaemic levels nearing the diabetes diagnostic threshold. Furthermore, the study found a moderate rise in mean glucose levels and HbA1c among those without baseline diabetes, and a significant worsening of glycemia among those with existing diabetes.

 

Implications for Practice:

The findings highlight a moderate, dose-dependent risk of new-onset diabetes associated with statin therapy, especially in individuals close to the diagnostic threshold for diabetes. These results should be considered in the clinical management of statin therapy, balancing the small increases in glycemia against the substantial benefits of statins in reducing cardiovascular risk. Healthcare providers should monitor glycaemic control in patients on statin therapy, particularly those prescribed high-intensity doses.

 

Reference (free full-text):

Cholesterol Treatment Trialists’ (CTT) Collaboration. (2024). Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. Lancet Diabetes & Endocrinology, (Online First), 1-12. DOI: https://doi.org/10.1016/S2213-8587(24)00040-8

PCI vs. CABG in left main coronary disease patients with and without diabetes—a pooled analysis of 4 trials

22 Mar, 2024 | 11:41h | UTC

Study Design and Population: This research pooled individual patient data from four randomized clinical trials (SYNTAX, PRECOMBAT, NOBLE, and EXCEL), comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in 4393 patients with left main coronary artery disease. The trials included both patients with and without diabetes, allowing for a comparative analysis of outcomes based on the revascularization method and the presence of diabetes.

Main Findings: Patients with diabetes exhibited higher rates of 5-year mortality, spontaneous myocardial infarction (MI), and repeat revascularization compared to those without diabetes. However, mortality rates following PCI vs. CABG were similar in diabetic (15.3% vs. 14.1%, respectively) and non-diabetic patients (9.7% vs. 8.9%, respectively). PCI was associated with a lower risk of stroke within the first year post-operation across all patients. Notably, diabetic patients underwent higher rates of spontaneous MI and repeat revascularization after PCI compared to CABG, with a more significant absolute excess risk observed beyond the first year compared to non-diabetic patients.

Implications for Practice: For patients with left main disease deemed suitable for either PCI or CABG, diabetes status significantly influences long-term outcomes, including death and cardiovascular events. While PCI offers a lower early risk of stroke, it is associated with increased risks of spontaneous MI and repeat revascularization, particularly in diabetic patients. These findings underscore the importance of considering patient-specific factors, such as diabetes status, in choosing between PCI and CABG for left main coronary artery disease revascularization.

Reference

Prakriti Gaba et al. (2024). Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation, 0. DOI: 10.1161/CIRCULATIONAHA.123.065571. Access the study here: Link

Meta-Analysis: No mortality benefit of early vs. delayed/selective coronary angiography in out-of-hospital cardiac arrest without ST-elevation

21 Mar, 2024 | 11:40h | UTC

Study Design and Population: This article presents a systematic review and meta-analysis of five randomized controlled trials comparing early/immediate versus delayed/selective coronary angiography (CAG) in 1512 patients who experienced out-of-hospital cardiac arrest (OHCA) without ST-segment elevation. The population had a mean age of 67 years, with 26% female and 23% having a prior myocardial infarction. Follow-up duration was at least 30 days across included studies.

Main Findings: The analysis revealed no significant difference in the odds of all-cause death between early/immediate and delayed/selective CAG strategies (Odds Ratio [OR] 1.12, 95% CI 0.91–1.38). Similar results were found for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95% CI 0.89–1.36). Subgroup analysis showed no significant effect modification based on age, initial cardiac rhythm, history of coronary artery disease, the presumed ischemic cause of arrest, or time to return of spontaneous circulation. Interestingly, a trend toward increased odds of death was observed in women receiving early CAG compared to men, although this finding approached but did not reach statistical significance.

Implications for Practice: The findings suggest that for OHCA patients without ST-segment elevation, an early/immediate CAG strategy does not confer a mortality benefit over a delayed/selective approach across major subgroups. Notably, the potential for increased mortality risk in women with early CAG warrants further investigation. Clinicians should consider these results when deciding on the timing of CAG in this patient population, keeping in mind the overall lack of mortality benefit and the nuanced differences among subgroups.

Reference: Fardin Hamidi et al. (2023). Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials. Clinical Research in Cardiology, 113(561–569). Access the study here: [Link]

2023 AHA/ACC Guideline for chronic coronary disease – B-blockers downgraded in patients without recent MI or low ejection fraction

21 Jul, 2023 | 13:52h | UTC

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines – Journal of the American College of Cardiology

Key Perspectives: 2023 Multisociety Guideline for Managing Chronic Coronary Disease – American College of Cardiology

Top things to know: 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease – American Heart Association

News Releases:

Symptom relief and healthy habits are top goals for treating chronic heart disease – American Heart Association

New ACC, AHA, Multi-Society Guideline Addresses Management of Chronic Coronary Disease – American College of Cardiology

Commentary: New Chronic Heart Disease Guidelines Update Roles of GDMT, Imaging, and Revascularization – TCTMD

 

Commentary on Twitter with key points (thread – click for more)

 

M-A | P2Y12 inhibitors show superior efficacy over aspirin for secondary prevention in CAD

11 Jul, 2023 | 14:06h | UTC

P2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Related:

Monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta-analysis – The Lancet (link to abstract – $ for full-text)

RCT | Clopidogrel is better than Aspirin for chronic maintenance monotherapy after percutaneous coronary intervention.

Meta-analysis of randomized trials: Clopidogrel is better than aspirin for the secondary prevention of cardiovascular events.

#ACC21 – RCT: Clopidogrel better than aspirin for chronic maintenance monotherapy after percutaneous coronary intervention.

 

Commentary on Twitter

 

M-A | Coronary revascularization in HF and CAD: a small but significant effect on mortality

2 Jun, 2023 | 12:31h | UTC

Coronary revascularization for heart failure with coronary artery disease: a systematic review and meta-analysis of randomized trials – European Journal of Heart Failure

 

Consensus Paper | Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease

10 May, 2023 | 15:51h | UTC

Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease: 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), Association for Acute CardioVascular Care (ACVC) and European Association of Preventive Cardiology (EAPC) – European Heart Journal – Cardiovascular Pharmacotherapy

 

Review | The bidirectional association between atrial fibrillation and myocardial infarction

8 May, 2023 | 12:54h | UTC

The bidirectional association between atrial fibrillation and myocardial infarction – Nature Reviews Cardiology (if the link is paywalled, try this one)

 

Commentary on Twitter

 

Cohort Study | Subclinical coronary atherosclerosis and risk for myocardial infarction

31 Mar, 2023 | 13:36h | UTC

Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort: A Prospective Observational Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)

Commentary: CTA-detected coronary artery disease associated with increased risk for myocardial infarction – ACP Internist

Related:

M-A: Evaluation of the incremental value of a coronary artery calcium score beyond traditional cardiovascular risk assessment.

New study challenges the idea that a coronary artery calcium score of 0 is enough for ruling out coronary stenosis in symptomatic patients, especially in young adults.

Cohort Study: Coronary Artery Calcium and Long-Term Risk of Death, Myocardial Infarction, and Stroke

USPSTF Statement: Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors

Research: Coronary Artery Calcium Score for Long-term Risk Classification in Individuals With Type 2 Diabetes and Metabolic Syndrome

The 10-Year Prognostic Value of Zero and Minimal CAC

 

Guideline | Diagnosis and treatment of vasospastic angina and coronary microvascular dysfunction

23 Mar, 2023 | 12:53h | UTC

JCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction – Circulation Journal (see PDF)

 

SR | Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how

14 Mar, 2023 | 13:46h | UTC

Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How – Journal of the American Heart Association

 

M-A | Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk

8 Feb, 2023 | 12:16h | UTC

Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials – European Heart Journal (link to abstract – $ for full-text)

 

Commentary on Twitter

 

Machine learning-based marker for coronary artery disease: derivation and validation in two longitudinal cohorts

8 Feb, 2023 | 12:14h | UTC

Machine learning-based marker for coronary artery disease: derivation and validation in two longitudinal cohorts – The Lancet (link to abstract – $ for full-text)

News Release: Digital marker for coronary artery disease built by researchers at Mount Sinai

Commentary: Machine learning used to generate a new holistic model for coronary artery disease – News Medical

 

Commentary from the author on Twitter (thread – click for more)

 

Transfusion thresholds for acute coronary syndromes — insights from the TRICS‐III trial and meta‐analysis

3 Feb, 2023 | 13:58h | UTC

Transfusion Thresholds for Acute Coronary Syndromes—Insights From the TRICS‐III Randomized Controlled Trial, Systematic Review, and Meta‐Analysis – Journal of the American Heart Association

 

Risk and trajectory of premature ischemic CVD in women with a history of pre-eclampsia: a nationwide register-based study

30 Jan, 2023 | 01:08h | UTC

Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study – European Journal of Preventive Cardiology (free for a limited period)

News Release: Pre-eclampsia linked with four-fold higher risk of heart attack in decade after delivery – European Society of Cardiology

Commentaries:

Preeclampsia Increases Heart Attack, Stroke Risk for Up to 20 Years After Pregnancy – HCP Live

Preeclampsia in Pregnancy a Bad Sign for Women’s Future Heart Health – HealthDay

Related:

Cohort Study | Pre-eclampsia is associated with increased risk of premature-onset obstructive coronary artery stenosis.

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review – Journal of General Internal Medicine

Pregnancy Complications and Risk of Cardiovascular Disease Later in Life: A Nationwide Cohort Study – Journal of the American Heart Association

AHA Scientific Statement | Adverse Pregnancy Outcomes and Cardiovascular Disease Risk

Consensus statement: Cardiovascular health after menopause transition, pregnancy disorders, and other gynecologic conditions

Cohort Study: Preeclampsia and Cardiovascular Disease

Cohort Study: Cardiovascular Disease After Hypertensive Disorders of Pregnancy Largely Explained by Conventional Cardiovascular Risk Factors

All Hypertensive Disorders of Pregnancy Increase the Risk of Future Cardiovascular Disease

Gestational Hypertension and Future Risk of Cardiovascular Disease

Research: Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents

 

2023 Guidelines on the diagnosis and management of chronic coronary syndrome

25 Jan, 2023 | 11:25h | UTC

2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome – Acta Cardiologica Sinica

Related: 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology

 

Retrospective Study | Serial troponin-T and long-term outcomes in suspected acute coronary syndrome

24 Jan, 2023 | 14:09h | UTC

Serial troponin-T and long-term outcomes in suspected acute coronary syndrome – European Heart Journal

 

Commentary on Twitter

 

Review | Wellens syndrome: an important consideration in patients with chest pain

23 Jan, 2023 | 13:26h | UTC

Wellens syndrome: An important consideration in patients with chest pain – JAAPA

Commentary: Wellens Syndrome Important to Consider if Chest Pain: Key Points – American College of Cardiology

 

SR | Comparison of various calcium antagonists on vasospastic angina

18 Jan, 2023 | 14:16h | UTC

Comparison of various calcium antagonist on vasospastic angina: a systematic review – openheart

 

Stay Updated in Your Specialty

Telegram Channels
Free

WhatsApp alerts 10-day free trial

No spam, just news.