Coronary Insufficiency
PCI vs. CABG in left main coronary disease patients with and without diabetes—a pooled analysis of 4 trials
22 Mar, 2024 | 11:41h | UTCStudy 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 | UTCStudy 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 | UTCKey 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:
Commentary: New Chronic Heart Disease Guidelines Update Roles of GDMT, Imaging, and Revascularization – TCTMD
Commentary on Twitter with key points (thread – click for more)
?2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients w/ Chronic Coronary Disease aims to provide recommendations for diagnostic evaluation, symptom relief, improvement in QoL & reduction of future #ASCVD-related events & #heartfailure in patients w/ CCD.
— American College of Cardiology (@ACCinTouch) July 20, 2023
M-A | P2Y12 inhibitors show superior efficacy over aspirin for secondary prevention in CAD
11 Jul, 2023 | 14:06h | UTCP2Y12 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)
Commentary on Twitter
Given superior efficacy & similar overall safety, #P2Y12 inhibitor monotherapy might be preferred over #aspirin monotherapy for long-term secondary prevention in pts w/ established #cvCAD. https://t.co/EehIEuWqOt#JACC #P2Y12i #CardioTwitter @FeliceGragnano @vlgmrc @Drroxmehran pic.twitter.com/betLycXGs5
— JACC Journals (@JACCJournals) July 5, 2023
M-A | Coronary revascularization in HF and CAD: a small but significant effect on mortality
2 Jun, 2023 | 12:31h | UTC
Consensus Paper | Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease
10 May, 2023 | 15:51h | UTC
Review | The bidirectional association between atrial fibrillation and myocardial infarction
8 May, 2023 | 12:54h | UTCThe bidirectional association between atrial fibrillation and myocardial infarction – Nature Reviews Cardiology (if the link is paywalled, try this one)
Commentary on Twitter
In our latest Review, @JKornej, @EmeliaBenjamin et al. explore the bidirectional association between #AtrialFibrillation and myocardial infarction: https://t.co/K3iH24e57U pic.twitter.com/sKBrhRJXf3
— Nature Reviews Cardiology (@NatRevCardiol) April 17, 2023
Cohort Study | Subclinical coronary atherosclerosis and risk for myocardial infarction
31 Mar, 2023 | 13:36h | UTCSubclinical 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)
Related:
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
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 | UTCJCS/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
M-A | Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk
8 Feb, 2023 | 12:16h | UTCDual 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
Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomised trials https://t.co/bIX3fAuOEU @escardio #EHJ #ESCYoung #cardiotwitter @ehj_ed @rladeiraslopes pic.twitter.com/WuzOckXpFX
— European Society of Cardiology Journals (@ESC_Journals) December 20, 2022
Machine learning-based marker for coronary artery disease: derivation and validation in two longitudinal cohorts
8 Feb, 2023 | 12:14h | UTCMachine 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)
Christmas came early… my first paper of my postdoc is officially published @TheLancet!! https://t.co/pozEyRKkD0
This was a wild journey with the @DoGenetics lab to build a digital marker for heart disease using AI + electronic health records?? Here's why:
1/?— Iain S. Forrest, PhD (@IainSForrest) December 21, 2022
Transfusion thresholds for acute coronary syndromes — insights from the TRICS‐III trial and meta‐analysis
3 Feb, 2023 | 13:58h | UTC
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 | UTCRisk 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:
AHA Scientific Statement | Adverse Pregnancy Outcomes and Cardiovascular Disease Risk
Cohort Study: Preeclampsia and Cardiovascular Disease
All Hypertensive Disorders of Pregnancy Increase the Risk of Future Cardiovascular Disease
Gestational Hypertension and Future Risk of Cardiovascular Disease
2023 Guidelines on the diagnosis and management of chronic coronary syndrome
25 Jan, 2023 | 11:25h | UTC
Retrospective Study | Serial troponin-T and long-term outcomes in suspected acute coronary syndrome
24 Jan, 2023 | 14:09h | UTC
Commentary on Twitter
Serial troponin-T and long-term outcomes in suspected acute coronary syndrome https://t.co/cTm1fJTuKl#AHA22 @ehj_ed @rladeiraslopes pic.twitter.com/0p8cO8zhzi
— European Society of Cardiology Journals (@ESC_Journals) November 7, 2022
Review | Wellens syndrome: an important consideration in patients with chest pain
23 Jan, 2023 | 13:26h | UTCWellens 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 | UTCComparison of various calcium antagonist on vasospastic angina: a systematic review – openheart
The year in cardiovascular medicine 2022: the top 10 papers in acute cardiac care and ischemic heart disease
9 Jan, 2023 | 14:28h | UTC
Commentary on Twitter
The Year in Cardiovascular Medicine 2022 series: the Top 10 papers in Cardiovascular Imaging https://t.co/OVJxxYu71p@escardio #EHJ #ESCYoung #cardiotwitter @ehj_ed @rladeiraslopes #CVD #cvimaging @chiarabd @NAjmoneMarsan pic.twitter.com/sooF0bz3LN
— European Society of Cardiology Journals (@ESC_Journals) January 2, 2023
AHA Scientific Statement | Management of acute coronary syndrome in the older adult population.
13 Dec, 2022 | 14:35h | UTCNews Release: Hearts and bodies change with age, heart disease treatments may need to change, too – American Heart Association
Top Things to Know: Management of ACS in the Older Adult Population – American Heart Association
Commentaries:
The Management of ACS in Older Patients: Is Age Just a Number? – American Heart Association
RCT | Utility of coronary CT angiography for patients with suspected acute coronary syndrome.
9 Dec, 2022 | 13:22h | UTCProspective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) – Heart
Commentary on Twitter
PROTECCT Trial @Heart_BMJ shows that immediate coronary CT in ED does not reduce length of stay in patients with suspected #AcuteCoronarySyndrome that cannot be ruled in/out on first #Troponin. @TheBHF @kingscardio @KingsImaging @GSTTresearch https://t.co/ud4rxEpmKl pic.twitter.com/YmKXFWIBZd
— Cardiac Research (@UKheartresearch) October 27, 2022
Under a http://creativecommons.org/licenses/by-nc/4.0/ License
Cohort Study | Race-dependent association of HDL-C levels with incident coronary artery disease.
23 Nov, 2022 | 14:02h | UTCNews Release: Study challenges “good” cholesterol’s role in universally predicting heart disease risk – National Institutes of Health
RCT | Clopidogrel is better than Aspirin for chronic maintenance monotherapy after percutaneous coronary intervention.
17 Nov, 2022 | 12:30h | UTCRelated:
Commentary on Twitter
https://twitter.com/CircAHA/status/1589647384073703426
RCT | Bivalirudin is superior to heparin in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
15 Nov, 2022 | 13:00h | UTCCommentaries:
BRIGHT-4: Large, ‘Clean’ Trial Clarifies Bivalirudin Benefits in STEMI – TCTMD
RCT | Indobufen vs. aspirin on top of clopidogrel after coronary drug-eluting stent implantation.
11 Nov, 2022 | 14:03h | UTC
Commentary on Twitter
#OriginalResearch simpub #AHA2022 #CIRCAHA22: In this #RCT, indobufen + clopidogrel DAPT compared with aspirin + clopidogrel DAPT significantly reduced the risk of 1-year net clinical outcomes, mainly driven by a reduction in bleeding events without an ….https://t.co/ctk1fwhXt2 pic.twitter.com/vFPS6gvpjN
— Circulation (@CircAHA) November 6, 2022