Shows
Star Update Podcast - Cardiology News SummariesClinical Efficacy and Safety of Early Intravenous Administration of Beta-Blockers in Patients Suffering from Acute ST-Segment Elevation Myocardial Infarction without Heart Failure Undergoing Primary PClinical Efficacy and Safety of Early Intravenous
Administration of Beta-Blockers in Patients Suffering from Acute ST-Segment Elevation
Myocardial Infarction without Heart Failure Undergoing Primary Percutaneous
Coronary Intervention: A Study-Level Meta-Analysis of Randomized Clinical
Trials
Cardiovasc Drugs Ther. 2023 Apr 1.doi: 10.1007
Background: Several clinical studies have produced diverse results regarding
the efficacy and safety of early intravenous beta-blockers in patients with
acute ST-segment elevation myocardial infarction (STEMI). A study-level
meta-analysis of randomized clinical trials (RCTs) comparing early intravenous
beta-blockers versus placebo or routine care in STEMI patients undergoing
primary percutaneous coronary intervention (PCI) was performed.
Me...
2023-05-0204 minStar Update Podcast - Cardiology News SummariesSex-related bleeding risk in acute coronary syndrome patients receiving dual antiplatelet therapy with aspirin and a P2Y12 inhibitorSex-related bleeding risk in acute coronary syndrome patients receiving dual antiplatelet therapy with aspirin and a P2Y12 inhibitor
Med Princ Pract. 2023 Mar 22.
Abstract
Aims To study sex differences in major bleeding in relation to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods and results The Collective Cardiology Research registry was designed to evaluate the application and outcomes of DAPT after ACS/PCI in the Rijnmond region in the Netherlands. Overall, 1172 women (median age 67.5 years) and 3087 men (62.2 years) with ACS/PCI were enrolled...
2023-03-3002 minStar Update Podcast - Cardiology News SummariesEffect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trialsEffect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trials
Clin Cardiol. 2022 Oct;45(10):1011-1028.
Abstract
Aim: This meta-analysis aims to look at the impact of early intravenous Metoprolol in ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction.
Methods: We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science...
2023-03-3002 minStar Update Podcast - Cardiology News SummariesBeta-Blockers for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: An Updated Meta-Analysis of Randomized Clinical TrialsBeta-Blockers for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: An Updated Meta-Analysis of Randomized Clinical Trials
Cardiovasc Ther. 2022 Dec 29;2022:8367444.
Abstract
Aim: Cardiotoxicity is a well-recognized complication of chemotherapy with Anthracyclines. However, results from trials evaluating beta-blockers for prevention are controversial. Therefore, we performed a meta-analysis to find whether prophylactic administration of beta-blockers can help prevent Anthracyclines-induced cardiotoxicity.
Methods: We assessed randomized trials and observational studies where a prophylactic intervention was compared with a control arm in patients with a normal left ventricular ejection fraction (LVEF) receiving...
2023-03-3002 minStar Update Podcast - Cardiology News SummariesCan platelet count be controlled with ticagrelor in patients with essential thrombocythaemia? A case seriesCan platelet count be controlled with ticagrelor in patients with essential thrombocythaemia? A case series
Eur Heart J Case Rep. 2023 Feb 14;7(2):ytad051
Abstract
Background: Essential thrombocythaemia (ET) is defined as a myeloproliferative neoplasm with a tendency to haemorrhage and thrombosis. Acute coronary thrombosis can be observed in 1 out of 10 patients. The management of ET patients with acute coronary syndrome (ACS) is a complex clinical condition that requires close follow-up.
Case summary: Case-1: a 52-year-old female patient with a diagnosis of ET with Janus kinase (JAK...
2023-03-3001 minStar Update Podcast - Cardiology News SummariesInterventional therapy of acute coronary syndromes in very old patient population and results of 2 years follow-upInterventional therapy of acute coronary syndromes in very old patient population and results of 2 years follow-up
Egypt Heart J. 2023 Feb 22;75(1):14. doi: 10.1186/s43044-023-00340-x.
Abstract
Background:Research on cardiovascular treatment options and prognosis in very old age groups of patients is warranted. In our study, we evaluated and followed up on clinical conditions on admission and comorbidities of patients older than 80 years who were admitted to our hospital with acute myocardial infarction and shared our findings.
Results:A total of 144 patients were included in the study, with a mean age...
2023-03-0201 minStar Update Podcast - Cardiology News SummariesBlood pressure lowering effects of β-blockers as add-on or combination therapy: A meta-analysis of randomized controlled trialsBlood pressure lowering effects of β-blockers as add-on or combination therapy: A meta-analysis of randomized controlled trials
J Clin Hypertens (Greenwich). 2023 Feb 8. doi: 10.1111/jch.14616. Online ahead of print.
Abstract:
The authors performed a meta-analysis to assess the efficacy of non-atenolol β-blockers as add-on to monotherapy or as a component of combination antihypertensive therapy in patients with hypertension. The authors searched and identified relevant randomized controlled trials from PubMed until November 2021. Studies comparing blood pressure lowering effects of β-blockers with diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) wer...
2023-03-0201 minStar Update Podcast - Cardiology News SummariesA predictive model of response to metoprolol in children and adolescents with postural tachycardia syndromeA predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome
World J Pediatr. 2023 Feb 13. doi: 10.1007/s12519-022-00677-4. Online ahead of print.
Abstract
Background:The present work was designed to explore whether electrocardiogram (ECG) index-based models could predict the effectiveness of metoprolol therapy in pediatric patients with postural tachycardia syndrome (POTS).
Methods:This study consisted of a training set and an external validation set. Children and adolescents with POTS who were given metoprolol treatment were enrolled, and after follow-up, they were grouped into non-responders and...
2023-03-0203 minStar Update Podcast - Cardiology News SummariesTicagrelor With or Without Aspirin in High-Risk Patients With Anemia Undergoing Percutaneous Coronary Intervention: a subgroup analysis of the TWILIGHT trialTicagrelor With or Without Aspirin in High-Risk Patients With Anemia Undergoing Percutaneous Coronary Intervention: a subgroup analysis of the TWILIGHT trial
Eur Heart J Cardiovasc Pharmacother. 2023 Jan 17;pvad006.
Abstract
Aim: The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anemia undergoing percutaneous coronary intervention (PCI).
Methods and results:In the TWILIGHT trial (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention), after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year...
2023-03-0201 minStar Update Podcast - Cardiology News SummariesStroke Recurrence and Antiplatelets in Posterior Versus Anterior Circulation Minor Stroke or Transient Ischemic AttackStroke Recurrence and Antiplatelets in Posterior Versus Anterior Circulation Minor Stroke or Transient Ischemic Attack
Stroke. 2023 Feb 15. doi: 10.1161/STROKEAHA.122.041738.
Abstract
Background:It is unclear whether infarct location affects stroke recurrence after index ischemic stroke. We aimed to compare the risk of stroke recurrence and the responses to dual antiplatelets with ticagrelor-aspirin versus clopidogrel-aspirin between patients with posterior circulation infarct (PCI) and those with anterior circulation infarct (ACI) after minor stroke or transient ischemic attack.
Methods:Data were obtained from the double-blind CHANCE-2 trial (Ticagrelor or Clopidogrel With Aspirin in High-Risk Patients...
2023-03-0202 minStar Update Podcast - Cardiology News SummariesAssociation between the number of academic research consortium for high bleeding risk (ARC-HBR) criteria and clinical outcomes in patients with acute coronary syndromeAbstract
Background: Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria have been used to identify high-risk patients undergoing percutaneous coronary intervention (PCI) in current clinical practice. This study aimed to evaluate the association between the number of ARC-HBR criteria and clinical outcomes in patients with acute coronary syndrome (ACS) after an emergent PCI.
Methods: We assessed 338 consecutive patients with ACS who underwent successful emergent PCI between January 2017 and December 2020. The ARC-HBR score was calculated by assigning 1 point to each major criterion and 0.5 points to each minor criterion. The patients were classified into low (ARC-HBR...
2023-01-3102 minStar Update Podcast - Cardiology News SummariesRole of β-blockers in Preventing Heart Failure and Major Adverse Cardiac Events Post Myocardial InfarctionAbstract
β-blockers have been widely utilized as a part of acute myocardial infarction (AMI) treatment for the past 40 years. Patients receiving β-adrenergic blockers for an extended period following myocardial infarction have a higher chance of surviving. Although many patients benefited from β-blockers, many do not, including those with myocardial infarction, left ventricle dysfunction, chronic pulmonary disease, and elderly people. In individuals with post-acute coronary syndrome and normal left ventricular ejection fraction (LVEF), the appropriate duration of beta-blocker therapy is still unknown. There is also no time limit for those without cardiac angina and who do not need β-blo...
2023-01-3101 minStar Update Podcast - Cardiology News SummariesBaroreflex sensitivity predicts therapeutic effects of metoprolol on pediatric postural orthostatic tachycardia syndromeAbstract
Objective: To determine if the baseline baroreflex sensitivity (BRS) could be a useful predictor for the metoprolol therapeutic efficacy on postural orthostatic tachycardia syndrome (POTS) in children.
Methods: In this retrospective case-control study, 54 children suffering from POTS treated with metoprolol were recruited from the pediatric department of Peking University First Hospital. After 2-3 months of metoprolol treatment, all subjects were divided into responders and non-responders based on whether the symptom score (SS) was decreased by over 50% after metoprolol treatment at the follow-up. The baseline demographic parameters and the supine BRS during the head-up tilt...
2023-01-3102 minStar Update Podcast - Cardiology News SummariesTicagrelor inhibits platelet aggregation and reduces inflammatory burden more than clopidogrel in patients with stages 4 or 5 chronic kidney diseaseAbstract
Background: No study has compared pharmacologic properties of ticagrelor and clopidogrel in non-dialysis patients with stage 4-5 chronic kidney disease (CKD).
Methods: We conducted a double-blind RCT to compare effects of ticagrelor and clopidogrel in 48 CKD, with the primary outcome of ADP-induced platelet aggregation (WBPA) after 2 weeks of DAPT. In a parallel arm, we compared effects of 2 weeks of ticagrelor plus aspirin on mean changes in WBPA and markers of thromboinflammation among non-CKD controls (n = 26) with that of CKD in the ticagrelor-arm.
Results: Average age of CKD was 53.7 years, with 62% women, 54% African...
2023-01-3102 minStar Update Podcast - Cardiology News SummariesThe prognostic effect of ST-elevation in lead aVR on coronary artery disease, and outcome in acute coronary syndrome patients: a systematic review and meta-analysisThe prognostic effect of ST-elevation in lead aVR on coronary artery disease, and outcome in acute coronary syndrome patients: a systematic review and meta-analysis
Eur J Med Res. 2022 Dec 21;27(1):302.
Abstract
Background: Rapid diagnosis of coronary artery disease has an important role in saving patients. The aim of this study is to evaluate if aVR lead ST-elevation (STE) can predict LM/3VD, left main (LM) disease, and three-vessel disease (3VD), outcome in acute coronary syndrome (ACS) patients.
Methods: In this systematic review and meta-analysis, 45 qualified studies were entered. Scopus, Pub med, Google...
2022-12-2602 minStar Update Podcast - Cardiology News SummariesCardio-selective versus non-selective β-blockers for cardiovascular events and mortality in long-term dialysis patients: A systematic review and meta-analysisCardio-selective versus non-selective β-blockers for cardiovascular events and mortality in long-term dialysis patients: A systematic review and meta-analysis
PLoS One. 2022 Dec 19;17(12):e0279171.
Abstract
Background: Trials in patients receiving dialysis have demonstrated that β-blockers reduce all-cause mortality and cardiovascular events. However, differences still exist within-class comparative effectiveness studies of the therapeutic benefits of β-blockers in dialysis patients.
Objective: The purpose of this systematic review is to examine whether cardiovascular events and all-cause mortality differed between dialysis patients receiving cardio-selective and non-selective agents.
Methods: A comprehensive search of relevant articles from the...
2022-12-2602 minStar Update Podcast - Cardiology News SummariesEfficacy of metoprolol plus atorvastatin for carotid atherosclerosis and its influence on carotid intima-media thickness and homocysteine levelEfficacy of metoprolol plus atorvastatin for carotid atherosclerosis and its influence on carotid intima-media thickness and homocysteine level
Abstract
Objective: To analyze the effects of metoprolol (MET) plus atorvastatin (ATO) on carotid intima-media thickness (IMT) and homocysteine (Hcy) level in carotid atherosclerosis (CAS) patients.
Methods: In this retrospective study, 90 patients with CAS admitted to the Hangzhou Ninth People's Hospital between January 2019 and July 2021 were enrolled, including 40 cases (control group, the Con) treated with MET and 50 cases treated with the combination therapy of MET plus ATO (Research group, the Res). The efficacy and related...
2022-12-2601 minStar Update Podcast - Cardiology News SummariesTreatment of the New Era: Long-Term Ticagrelor Monotherapy for the Treatment of Patients with Type 2 Diabetes Mellitus following Percutaneous Coronary Intervention: A Meta-analysisTreatment of the New Era: Long-Term Ticagrelor Monotherapy for the Treatment of Patients with Type 2 Diabetes Mellitus following Percutaneous Coronary Intervention: A Meta-analysis
Abstract:
Introduction: Type 2 diabetes mellitus (T2DM) is a risk factor for the development of coronary artery disease (CAD). In patients with acute coronary syndrome (ACS), guidelines recommend a potent P2Y12 inhibitor in addition to aspirin. For those with complicated and advanced CAD requiring complex percutaneous coronary intervention (PCI), the risk for adverse ischemic events is even higher. Prolonged dual antiplatelet therapy (DAPT) use is controversial. A new antiplatelet regimen after...
2022-12-2603 minStar Update Podcast - Cardiology News SummariesAssociations of systemic inflammation and social support with suicidal ideation in patients with acute coronary syndrome and strokeAbstract
Background: This study aimed to investigate associations of serum high-sensitivity C-reactive protein (hsCRP) and social support (SS) levels with suicidal ideation (SI), and to evaluate potential modifying effects of SS on the associations between serum hsCRP levels and SI in two longitudinal cohorts with cardio-/cerebrovascular diseases.
Methods: 1152 acute coronary syndrome (ACS) and 423 stroke patients were recruited at baseline within 2 weeks of disease onset, and evaluated for: i) serum hsCRP levels; ii) SS by the Social Support Scale and Social Undermining Scale; iii) SI by the "suicidal thoughts" item of the Montgomery-Åsberg Depression R...
2022-12-0302 minStar Update Podcast - Cardiology News SummariesComparison of Rate Control Efficacy between beta-blockers and Calcium Channel Blockers in Patients Hospitalized with Atrial FibrillationAbstract
Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. Previous studies showed that rhythm and rate control strategies are associated with similar rates of mortality and serious morbidity. Beta blockers (BB) and calcium channel blockers (CCB) are commonly used and the selection between these two medications depends on personal preference.
Objectives: To compare real-time capability of BB and CCB for the treatment of rapid AF and to estimate their efficacy in reducing hospitalization duration.
Methods: We conducted a retrospective cohort study of 306 patients hospitalized at Soroka Hospital during a 5-year period...
2022-12-0302 minStar Update Podcast - Cardiology News SummariesMetoprolol Mitigates Ischemic Heart Remodeling and Fibrosis by Increasing the Expression of AKAP5 in Ischemic HeartAbstract
The harm of heart failure mainly causes patients to develop dyspnea, fatigue, fluid retention, and other symptoms, which impair patients' activity tolerance and lead to a dramatic decrease in patients' quality of life. The purpose of this study was to verify whether metoprolol regulates AKAP5 expression and test the role of AKAP5 postinjury in mitigating cardiac infarction-associated tissue remodeling and fibrosis. Sprague-Dawley (SD) rats underwent coronary artery ligation (CAL), which was followed immediately with metoprolol daily. And western blot and coimmunoprecipitation experiments were performed to detect the expression of related proteins in the sham-operated group, model...
2022-12-0302 minStar Update Podcast - Cardiology News SummariesA randomized pilot study of the efficacy and safety of loading ticagrelor in acute ischemic strokeAbstract
Background: Ticagrelor is one of the most recent antiplatelet drugs to be approved to treat ischemic heart disease. Its efficacy may exceed aspirin in improving clinical outcomes in patients with acute ischemic stroke who are ineligible for rt-PA.
Objectives: We evaluated the safety regarding hemorrhagic complications (as a primary endpoint) and the efficacy (as a secondary endpoint) of a 180-mg loading dose of ticagrelor given within 9 h from the onset of the first-ever non-cardioembolic ischemic stroke.
Methods: We conducted our study on patients aged 18-75 years who presented with their first clinically...
2022-12-0302 minStar Update Podcast - Cardiology News SummariesEfficacy and Safety of Sustained-Release Metoprolol with Dronedarone After Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: A Propensity Matched AnalysisEfficacy and Safety of Sustained-Release Metoprolol with Dronedarone After Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: A Propensity Matched Analysis
Am J Cardiol. 2022 Oct 15;S0002-9149(22)00898-0
Abstract
The high early recurrence (ER) rate after radiofrequency catheter ablation (RFCA) seriously affects the prognosis of patients with atrial fibrillation (AF), and there are still controversies regarding the best preventive drugs for postoperative recurrence. A single-center retrospective study was conducted on patients with paroxysmal atrial fibrillation (PAF) who received metoprolol sustained-release tablets combined with dronedarone (observation group) and dronedarone alone (control group) after...
2022-11-0202 minStar Update Podcast - Cardiology News SummariesIncidence and predictors of heart failure after acute coronary Syndrome: The CORALYS registryIncidence and predictors of heart failure after acute coronary Syndrome: The CORALYS registry
Int J Cardiol. 2022 Oct 25;S0167-5273(22)01658-8
Abstract
Background: Previous studies investigating predictors of Heart Failure (HF) after acute coronary syndrome (ACS) were mostly conducted during fibrinolytic era or restricted to baseline characteristics and diagnoses prior to admission. We assessed the incidence and predictors of HF hospitalizations among patients treated with percutaneous coronary intervention (PCI) for ACS.
Methods and results: CORALYS is a multicenter, retrospective, observational registry including consecutive patients treated with...
2022-11-0202 minStar Update Podcast - Cardiology News SummariesEffect of β-Blocker Therapy on the Level of Soluble ST2 Protein in Pediatric Dilated CardiomyopathyEffect of β-Blocker Therapy on the Level of Soluble ST2 Protein in Pediatric Dilated Cardiomyopathy
Medicina (Kaunas). 2022 Sep 23;58(10):1339
Abstract
Background and Objectives: A prognosis for kids with pediatric dilated cardiomyopathy (PDCM) is urgently needed to identify high-risk patients. This study aimed to determine the association of levels and soluble suppression of tumorigenicity 2 (sST2) and medical therapy of β-blocker inhibitors with the risk of adverse events in PDCM. Materials and Methods: A total of 124 patients with PDCM were enrolled after admission from 2 centers in China and followed up for adverse events (de...
2022-11-0201 minStar Update Podcast - Cardiology News SummariesClopidogrel resistance and ticagrelor replacement in dual antiplatelet therapy for carotid artery stentingClopidogrel resistance and ticagrelor replacement in dual antiplatelet therapy for carotid artery stenting
Ann Vasc Surg. 2022 Oct 18;S0890-5096(22)00640-9
Abstract
Objective: Resistance to the pharmacological effect of clopidogrel in patients undergoing dual antiplatelet therapy for carotid stenting may increase the risk of periprocedural neurological events. The purpose of the study was to describe the phenomenon of clopidogrel resistance in a series of patients undergoing carotid stenting.
Methods: Data of patients who consecutively underwent carotid stenting from 11/2016 to 12/2020 for a significant stenosis and who underwent...
2022-11-0202 minStar Update Podcast - Cardiology News SummariesEffect of early metoprolol before PCI in ST-segment elevation myocardial infarction on infarct size and left ventricular ejection fraction. A systematic review and meta-analysis of clinical trialsAbstract
Aim: This meta-analysis aims to look at the impact of early intravenous Metoprolol in ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI) on infarct size, as measured by cardio magnetic resonance (CMR) and left ventricular ejection fraction.
Methods: We searched the following databases: PubMed, Scopus, Cochrane library, and Web of Science. We included only randomized control trials that reported the use of early intravenous Metoprolol in STEMI before PCI on infarct size, as measured by CMR and left ventricular ejection fraction. RevMan software 5.4 was used for performing the analysis.
Results...
2022-10-0402 minStar Update Podcast - Cardiology News SummariesSafety and efficacy of dual antiplatelet therapy combining aspirin and ticagrelor in patients with undergoing intracranial stenting proceduresAbstract
Background: Thromboembolic complications are one of the major periprocedural complications following neuroendovascular procedures. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remain the principal agents for prevention of thromboembolic complications. However, clopidogrel resistance is associated with higher risk of thromboembolic complications. This study investigated the safety and efficacy of DAPT with ticagrelor and aspirin in patients undergoing intracranial stenting procedures.
Methods: This retrospective study was based on patients with intracranial aneurysms who undergoing intracranial stenting procedures at our institution between August 2017 and July 2020. These patients received DAPT with ticagrelor and aspirin were included. DAPT...
2022-10-0402 minStar Update Podcast - Cardiology News SummariesTicagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China SubstudyThe study is a double-blind, placebo-controlled, randomized TWILIGHT trial (Ticagrelor with Aspirin or Alone in High-Risk Patients After Coronary Intervention) that compared the use of ticagrelor with or without aspirin in the patients undergoing PCI. The study enrolled patients undergoing high-risk percutaneous coronary intervention. After 3 months of treatment with ticagrelor plus aspirin, event-free and adherent patients remained on ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. Out of 9006 enrolled and 7119 randomized patients in TWILIGHT, 1169 patients were enrolled at 27 Chinese sites in this prespecified sub study, of whom 1028 patients were randomized after 3 months. The incidence of th...
2022-10-0402 minStar Update Podcast - Cardiology News SummariesTicagrelor versus clopidogrel in reducing inflammatory cell infiltration of thrombus aspirated in patients with ST-elevation myocardial infarctionTicagrelor provides more rapid, potent, and consistent anti-platelet efficacy than clopidogrel. This study is a randomized trial that aimed to evaluate the anti-inflammatory effects of ticagrelor on thrombus aspirated from the ST-elevation myocardial infarction (STEMI) patients. The results were compared against clopidogrel.
The study was conducted among 98 patients with STEMI and intended percutaneous coronary intervention (PCI). The patients were divided into two groups to receive clopidogrel (600-mg loading dose) or ticagrelor (180-mg loading dose).
As compared with the clopidogrel group, the number of total inflammatory cells per mm2 thrombus area in the ticagrelor group was...
2022-10-0402 minStar Update Podcast - Cardiology News SummariesBeta-blockers in acute coronary syndrome: does rhythm matter?Beta-blockers in acute coronary syndrome: does rhythm matter?
The study aimed to assess and compare the in-hospital and 1-year prognostic impact of BB prescription after acute coronary syndrome (ACS), in patients with previous or de novo AF, and in patients with sinus rhythm (SR). It has been already known that beta-blockers (BB) are recommended in patients with previous acute myocardial infarction (AMI), aiming to reduce morbidity and mortality. Their benefit is greater in patients with associated left ventricular dysfunction. However, in patients with atrial fibrillation (AF), its prognostic benefit is controversial.
The...
2022-09-0202 minStar Update Podcast - Cardiology News SummariesMetoprolol improves left ventricular longitudinal function at rest and during exercise in obstructive hypertrophic cardiomyopathyMetoprolol improves left ventricular longitudinal function at rest and during exercise in obstructive hypertrophic cardiomyopathy
The following study aimed to characterize left ventricular (LV) systolic function by segmental and global longitudinal strain echocardiography and to investigate changes in relation to exercise, and the effect of standard treatment with beta-blockers. What we already know is that hypertrophic cardiomyopathy (HCM) patients with outflow obstruction often experience symptoms of heart failure upon exertion.
A total of 29 with obstructive HCM and New York Heart Association (NYHA) class ≥ II symptoms were enrolled in a double-blind, placebo-controlled, randomized cr...
2022-09-0202 minStar Update Podcast - Cardiology News SummariesBleeding outcomes with ticagrelor versus clopidogrel in patients with the acute coronary syndrome; a focused analysis from the multicenter CREA ARIAM Andalucia registryBleeding outcomes with ticagrelor versus clopidogrel in patients with the acute coronary syndrome; a focused analysis from the multicenter CREA ARIAM Andalucia registry
The question that usually arises is that, “What is the incidence, types, timing, and prognostic relevance of major bleeding events in ACS patients treated with ticagrelor or clopidogrel in contemporary practice”? What we already know is that with the use of various antithrombotic agents in acute coronary syndrome (ACS), bleeding has emerged as an important safety concern. Moreover, haemorrhagic complications have been strongly linked with subsequently mortality in this clinical scenario.
2022-09-0202 minStar Update Podcast - Cardiology News SummariesConservative management in a contemporary cohort of patients with acute coronary syndrome: Results from the FORCE-ACS registryConservative management in a contemporary cohort of patients with acute coConservative management in a contemporary cohort of patients with acute coronary syndrome: Results from the FORCE-ACS registry
The study aimed to evaluate conservative management compared with revascularization therapy in ACS patients, focused on ischemic and bleeding outcomes and to provide insights into the physician’s rationale of choice for conservative management. Currently, the evidence for conservatively managed patients with the acute coronary syndrome (ACS) is scarce.
A total of 5379 ACS patients were enrolled in the FORCE-ACS registry. Patients without coronary revascularization were identified and classified into three groups: patients where no coronary an...
2022-09-0202 minStar Update Podcast - Cardiology News SummariesCoronary Artery Embolism and Acute Coronary Syndrome: A critical appraisal of existing data TrendsAbstract
The occurrence of coronary artery embolism (CE) has been associated with various clinical conditions, including aortic and mitral prosthetic heart valve implantation, atrial fibrillation (AF), dilated cardiomyopathy, neoplasia, infective endocarditis, atrial septal defect, cardiac tumors, and hypercoagulable states. CE is also a rare cause of myocardial infarction (MI), with a prevalence of about 5%, a figure probably underestimated. The purpose of this article was to determine the current state of knowledge on acute coronary syndrome (ACS) related to CE. We thus performed a comprehensive structured literature search of the MEDLINE database for articles published between 1 January 1990 and 31...
2022-08-0502 minStar Update Podcast - Cardiology News SummariesImpact of body size on platelet function in patients with acute coronary syndrome on dual antiplatelet therapyAbstract
Introduction: Patients undergoing acute percutaneous coronary intervention receive dual antiplatelet therapy for secondary prevention. Recurrent myocardial infarction or bleedings are possibly due to under- or overdosing of antiplatelet therapy in relation to body size.
Methods: We correlated residual platelet aggregation with body mass index, body surface area, lean body mass and blood volume in 220 patients on prasugrel (n = 121) or ticagrelor (n = 99).
Results: Platelet aggregation outside the recommended window was recorded in 85 patients, but not correlated with any of the body indices.
Conclusion: Body size does not affect platelet response to...
2022-08-0501 minStar Update Podcast - Cardiology News SummariesBeta-blocker Use After Thoracic Endovascular Aortic Repair in Patients with Type B Aortic Dissection Is Associated with Improved Early Aortic RemodelingAbstract
Objective: Beta-blockers are first-line anti-impulse therapy in patients presenting with acute type B aortic dissection (TBAD). However, little is understood about their impact after aortic repair. The aim of this study was to evaluate the role of postoperative beta-blocker use on outcomes of thoracic endovascular aortic repair (TEVAR) in TBAD.
Methods: The Vascular Quality Initiative database was queried for all patients undergoing TEVAR for TBAD from 2012 to 2020. Aortic-related reintervention, all-cause mortality and effect of TEVAR on false lumen thrombosis of the treated aortic segment were assessed and compared between patients treated with and without...
2022-08-0503 minStar Update Podcast - Cardiology News SummariesImpact of Prasugrel and Ticagrelor on Platelet Reactivity in Patients With Acute Coronary Syndrome: A Meta-AnalysisAbstract
Background: This meta-analysis mainly aimed to compare the impact of prasugrel and ticagrelor on platelet reactivity (PR) in patients with acute coronary syndrome (ACS).
Methods: We searched four electronic databases to identify randomized controlled trials and cohort studies comparing the impact of prasugrel and ticagrelor on PR in patients with ACS. We performed group analyses according to three detection methods, drug dose [loading dose (LD) and maintenance dose (MTD)] and LD effect time, and assessed the robustness of the results through sensitivity analysis.
Results: Twenty-five studies with 5,098 patients were eligible. After LD...
2022-08-0502 min
Star Update Podcast - Cardiology News SummariesManagement of acute coronary syndrome without ST-segment elevation· ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute (NSTE-ACS) coronary syndrome are referred to collectively as acute coronary syndrome (ACS)
· The latter includes non-ST-segment elevation myocardial infarction and unstable angina pectoris (NSTEMI). Cardiovascular catheterization must be immediately recommended in cases of STEMI.
· The management and diagnosis of NSTE-ACS are more difficult. The most recent ESC treatment guidelines for NSTE-ACS were released in 2020 which cover the areas of diagnosis, risk assessment, antithrombotic therapy, invasive or non-invasive coronary diagnostics, and long-term management.
· In order to enable a quick triage decision (rule-in as possible NSTEMI or r...
2022-07-0101 minStar Update Podcast - Cardiology News SummariesThe impact of a comprehensive pharmaceutical care intervention in addition to cardiac rehabilitation program on outcomes of post-acute coronary syndrome patients: A pilot studyThe authors aimed to determine the efficacy of comprehensive pharmaceutical care intervention that included face-to-face education about the disease, healthy lifestyle, medication adherence, drug related problems management and goal setting which was added to cardiac rehabilitation program in improving echocardiographic parameters, nutritional status and High sensitivity C-Reactive Protein in patients with acute coronary syndrome. In this study, out of a total of 40 patients, 20 patients were randomized to the control group and 20 patients were randomized to the intervention group.
The following are key points to remember from this prospective study on the management of post ACS patients randomized...
2022-07-0101 minStar Update Podcast - Cardiology News SummariesEffects of Metoprolol Succinate Combined with Entresto on Cardiac Function Indexes and Coagulation Function in Patients with Congestive Heart FailureThe authors aimed to evaluate the effects of metoprolol succinate in combination with Entresto (Sacubitril Valsartan Sodium Tablets) on cardiac function and coagulation function in patients with congestive heart failure (CHF). A total of 120 patients were included in this study and patients were randomly assigned to control group and study group. In the control group, patients were prescribed with metoprolol succinate sustained-release tablets and the patients in the study group were prescribed with metoprolol succinate sustained-release tablets combined with Entresto.
The following are key points to remember from this study on the management of patients with CHF...
2022-07-0102 minStar Update Podcast - Cardiology News SummariesComparative Safety and Effectiveness of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndrome: An On-Treatment Analysis from a Multicentre RegistryObservational studies that failed to take time-dependent confounders into account have lately called into doubt the net therapeutic advantage of ticagrelor over clopidogrel in acute coronary syndrome (ACS). The authors aimed to evaluate the comparative safety and efficacy of ticagrelor vs. clopidogrel in real-life setting by taking into account the non-adherence of the therapy.
The following are key points to remember from this prospective, multi-cohort study on the outcomes in ACS patients discharged on ticagrelor or clopidogrel:
Out of a total of 2070 patients, 1,035 patients were discharged on ticagrelor and clopidogrel, respectively.
When compared to clopidogrel users...
2022-07-0101 minStar Update Podcast - Cardiology News SummariesIncidence, clinical characteristics, and impact of acute coronary syndrome following transcatheter aortic valve replacementTranscatheter aortic valve replacement (TAVR) has become a well-established therapy for patients with severe, symptomatic aortic stenosis who are at intermediate-to-high surgical risk over last decade. Aortic stenosis and coronary artery disease (CAD) have similar risk factors and pathogenic pathways, and 40% to 75% of TAVR patients had significant CAD.
In patients with severe CAD following aortic valve replacement, current recommendations advocate coronary revascularization (Class IIa, Level of Evidence: C). Patients who underwent TAVR at our facility on consecutive days between May 2007 and November 2017 were included. Patients were observed for one, six, and twelve months, and then once a...
2022-05-3101 min
Star Update Podcast - Cardiology News SummariesEfficacy and Safety of Ticagrelor Over Time in Patients with Prior MI in PEGASUS-TIMI 54Ticagrelor lowers ischemia risk in patients who have had a previous heart attack (MI). It's uncertain whether the risks of ischemic stroke and the advantages of long-term P2Y12 inhibition in this cohort are stable over time. The goal of the trial was to see how ischemia risk changed over time and if the efficacy and safety of ticagrelor were the same early and late after randomization.
The PEGASUS-TIMI (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction) 54 trial randomised patients with a...
2022-05-3101 minStar Update Podcast - Cardiology News SummariesTicagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBRPatients at a high risk of bleeding (HBR) are a common subgroup of those receiving percutaneous coronary intervention (PCI). After a short period of dual antiplatelet treatment (DAPT), early aspirin discontinuation has emerged as a bleeding prevention technique. It has been demonstrated by TWILIGHT trial that ticagrelor monotherapy is an effective and safe bleeding prevention approach for high-risk PCI patients, following a short course of DAPT.
TWILIGHT-HBR was conducted with the pre-specified analysis of TWILIGHT trial to determine the treatment effects of ticagrelor monotherapy compared with ticagrelor plus aspirin in a contemporary high-bleeding risk group. In this...
2022-05-3101 minStar Update Podcast - Cardiology News SummariesTicagrelor with or without Aspirin in High-Risk Patients after PCIAfter a minimum term of dual antiplatelet medication, monotherapy with a P2Y12 inhibitor is an emerging strategy for reducing the risk of bleeding after percutaneous coronary intervention (PCI). This Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention (TWILIGHT) trial was designed to test the hypothesis that a 3-month course of dual antiplatelet therapy with ticagrelor plus aspirin followed by ticagrelor monotherapy is superior to ticagrelor plus aspirin in patients undergoing PCI who are at risk of ischemic or hemorrhagic complications.
In this double-blind trial, the effects of ticagrelor monotherapy vs. ticagrelor plus aspirin...
2022-05-2701 minStar Update Podcast - Cardiology News SummariesTiming of Oral P2Y12 Inhibitor Administration in Patients with Non-ST-Segment Elevation Acute Coronary SyndromeThe optimal timing of oral P2Y12 inhibitors administration is not well-defined even though they remain the main-stay treatment in the management of patients with non–ST-segment elevation acute coronary syndrome. In the theoretical knowledge, administration of an oral P2Y12 inhibitor before defining coronary anatomy provides more ischemic protection while patients are waiting to undergo coronary angiography and reduces the risk of periprocedural thrombotic complications among those undergoing percutaneous coronary interventions.
A randomized, adaptive, open-label, multicentre clinical trial was conducted that included 1,449 patients. These patients were randomized to downstream or upstream oral P2Y12 inhibitor administration. Th...
2022-05-2701 min
Star Update Podcast - Cardiology News SummariesEffect of Ticagrelor Monotherapy vs Ticagrelor with Aspirin on Major Bleeding and Cardiovascular Events in Patients with Acute Coronary Syndrome: The TICO Randomized Clinical TrialIn the TICO randomized clinical trial, stopping aspirin was tested as a bleeding reduction method after short-term dual anti-platelet treatment (DAPT). However, ticagrelor monotherapy has not been studied in patients with acute coronary syndromes solely (ACS). The objective of this study was to determine whether moving to ticagrelor monotherapy in patients with ACS treated with drug-eluting stents, after 3 months of DAPT lowers net adverse clinical events compared to ticagrelor-based 12-month DAPT.
This randomized controlled trial was conducted in 3056 patients with ACS treated with drug-eluting stents between August 2015 and October 2018 were included in this trial. The patients were...
2022-05-2702 minStar Update Podcast - Cardiology News SummariesLow-Dose Triple Combination Antihypertensive Therapy vs Usual Care and Time at Target Blood PressureThis secondary analysis of an open-label randomized controlled clinical trial evaluated whether low-dose triple combination antihypertensive therapy helps patients with mild to moderate hypertension to stay at target blood pressure longer than usual care.
The triple therapy combination pill contained telmisartan 20 mg, amlodipine 2.5 mg, and chlorthalidone 12.5 mg. In this triple FDC therapy versus usual care, the main endpoints were between-group differences in time at target compared over 24 weeks of follow-up, with time at target defined as percentage of time at target BP.
Almost twice as many patients receiving triple pill therapy achieved more than 50% time...
2022-05-0401 minStar Update Podcast - Cardiology News SummariesInitial Decline in eGFR After Dapagliflozin Initiation and Its Associated Outcomes in Patients with HFrEFIn this post hoc analysis, the frequency of occurrence of an early decline ("dip") in estimated glomerular filtration rate (eGFR) after initiation of dapagliflozin, and its association with outcomes, was evaluated in heart failure patients participated in DAPA- HF trial.
The mean change in eGFR between day 0 and 14 was -1.1 with placebo and -4.2 with dapagliflozin, giving a intergroup difference of 3.1.
Overall, 38.2% of patients — with older age, lower baseline eGFR, higher LVEF, and type 2 diabetes — experienced a >10% early decline in eGFR with dapagliflozin compared with placebo (OR, 2.36).
In the dapagliflozin group, a >10% initial decl...
2022-05-0402 minStar Update Podcast - Cardiology News SummariesElevated Lipoprotein(a) and Risk of Atrial FibrillationAs we know, Lipoprotein(a) [Lp(a)] is an established risk factor for coronary artery disease, large artery stroke, and aortic valve stenosis.
The authors measured and genetically predicted lipoprotein(a) [Lp(a)] levels of 4, 35,579 participants from the UK Biobank to investigate the role of Lp(a) in atrial fibrillation (AF) and whether its association is independent of atherosclerotic cardiovascular disease.
Interestingly, it was found that there was a 3% increased risk of AF for every 50 nmol/L increase in Lp(a) level.
In addition, there was no evidence of a risk-conferring effect from...
2022-05-0402 min
Star Update Podcast - Cardiology News SummariesDAPT Discontinuation, Platelet Reactivity, and Adverse Outcomes After PCiThis post hoc analysis of the ADAPT-DES study investigated the predictors of dual antiplatelet therapy (DAPT) discontinuation, associations between different types and timing of DAPT discontinuation with thrombotic events, and the impact of on-treatment high platelet reactivity in 8582 patients who were already receiving aspirin and clopidogrel after undergoing PCI.
In result it was seen that approximately 50% of patients discontinued DAPT within 2 years, with unplanned DAPT discontinuation occurring in 16.5% of patients and discontinuation of both aspirin and clopidogrel occurring in 29.8% of patients.
Also, unplanned discontinuation was associated with a significantly increased risk of a major adverse...
2022-05-0402 minStar Update Podcast - Cardiology News SummariesOral Anticoagulant treatment and the risk of dementia in patients with atrial fibrillation.This study compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large Australian cohort of primary care patients with atrial fibrillation.
During the mean follow‐up time of 3.7 ± 2.0 years, 425 patients had a documented diagnosis of dementia.
After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59; compared with nonusers.
Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49; 95% CI, 0.33–0.73; P
2022-04-0401 minStar Update Podcast - Cardiology News SummariesThe AMPLITUDE-O Trial : CVOT of Efpeglenatide, a new potent, exendin-4-based weekly subcutaneous GLP-1 receptor agonistEfpeglenatide, is a novel, exendin-4-based weekly GLP-1 Receptor agonist that is administered subcutaneously, it effectively lowers glucose levels in people with T2DM.
Recent guidelines have placed this class of agents as first-line glycemic-lowering therapy in people with baseline CVD, high risk for CVD, or chronic kidney disease (CKD)
The AMPLITUDE-O Trial enrolled 4,076 adults with T2DM who had an HbA1c >7.0% and either a baseline history of CVD (89.6%) or diabetic kidney disease (DKD) with an eGFR 300 mg/g) and an increase in UACR ≥ 30% from baseline, a sustained decrease of eGFR ≥ 40% for at least 30 days...
2022-04-0404 minStar Update Podcast - Cardiology News Summaries2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive SummaryTake-Home Message No. 1
Guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) now includes 4 medication classes 1) renin-angiotensin system inhibition with angiotensin receptor-neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), or angiotensin (II) receptor blockers (ARB) alone; 2) beta blockers; 3) mineralocorticoid receptor antagonists (MRAs); and 4) the new group, SGLT2i
Take-Home Message No. 2
Mildly reduced LVEF has new medication recommendations, including use of SGLT2i. Weaker recommendations (COR 2b) are made for ARNi, ACEi, ARB, MRA and beta blockers in this population.
Take-Home Message No. 3
Preserved LVEF has new medication...
2022-04-0405 minStar Update Podcast - Cardiology News SummariesManaging Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art ReviewThere is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in 20- to 39-year age young adults. The authors update current thinking on lipid risk factors such as triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a). The authors review emerging strategies, such as coronary artery calcium and polygenic risk scores in this age group, Finally, the authors discuss both the obstacles and opportunities for addressing prevention in early adulthood.
Disclaimer: Lupin makes no representation or warranty...
2022-04-0405 minStar Update Podcast - Cardiology News SummariesTight control of blood pressure in pregnant women with non-severe hypertension: expectations for decreasing adverse maternal and fatal pregnancy outcomesIt has been controversial regarding blood pressure (BP) levels at which antihypertensive drug therapy should be started, and the adequate Blood pressure goal to be achieved following antihypertensive drug therapy in women with hypertensive disorders of pregnancy (HDP), which includes chronic hypertension (CH) as well as hypertension occurring at or after 20 weeks of gestation.
The Japan Society for the Study of Hypertension in Pregnancy (JSSHP) committee previously recommended that
● antihypertensive drug therapy should be initiated for pregnant women with severe hypertension (more than 160/110 mmHg),
● and BP should be maintained at 140–160/90–110 mmHg
However, con...
2022-03-0404 minStar Update Podcast - Cardiology News SummariesEffect of Chloride levels in HF therapyChloride is among the major electrolytes that play a unique role in fluid homeostasis and is associated with cardiorenal and neurohormonal systems.
Various HF therapies may cause hypochloremia, and hypochloremia itself can initiate and exacerbate diuretic resistance in HF.
The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and interactions of chloride abnormalities with HF-related factors and treatments.
Despite the long-standing focus of guidelines/clinicians on sodium’s role in HF, chloride is recently shown to have a...
2022-03-0401 minStar Update Podcast - Cardiology News SummariesEffects of Tirzepatide, a Dual GIP and GLP-1 RA, on Lipid and Metabolite Profiles in Subjects With Type 2 DiabetesTirzepatide is a dual GIP and GLP-1 receptor agonist under development for the treatment of type 2 diabetes mellitus (T2DM), obesity, and nonalcoholic steatohepatitis. Early phase trials in T2DM indicate that tirzepatide improves clinical outcomes beyond those achieved by a selective GLP-1 receptor agonist like dulaglutide
Improved glycemic control was associated with lower circulating triglycerides and lipoprotein markers and improved markers of beta-cell function and insulin resistance (IR)
In this Phase 2b trial participants were randomly assigned to receive weekly subcutaneous tirzepatide, dulaglutide, or placebo for 26 weeks. Post hoc exploratory metabolomics and lipidomics analyses...
2022-03-0402 minStar Update Podcast - Cardiology News SummariesMeta-Analysis Comparing Apixaban Versus Rivaroxaban for Management of Patients With Nonvalvular Atrial FibrillationSystematic review and meta-analysis of 10 real-world observational studies including patients with not valvular atrial fibrillation NVAF on apixaban and rivaroxaban was done to compare the efficacy and safety of apixaban and rivaroxaban for the prevention of stroke. Surprisingly, apixaban treatment showed significantly lower hazard of 0.8 or 20% Risk reduction in stroke/systemic embolism compared to rivaroxaban.
Also, meta-analysis for a major bleeding episode was significantly lower with 38% RR with apixaban compared with rivaroxaban
The risk of Gastrointestinal bleeding was 43% lower in Apixaban compared to Rivaroxaban.
In conclusion, this study suggests that CHA2DS2-VASc...
2022-03-0401 minStar Update Podcast - Cardiology News SummariesGastrointestinal Injury Caused by Aspirin or Clopidogrel Monotherapy Versus Dual Antiplatelet TherapyPatients who undergo percutaneous coronary intervention (PCI) with drug-eluting stents require dual antiplatelet therapy (DAPT) for at least 6 months for stable ischemic heart disease (SIHD) or 12 months for acute coronary syndromes (ACS) to prevent stent thrombosis and other cardiovascular events (1).
The rationale for using DAPT is that aspirin and a P2Y12 antagonist (such as clopidogrel, prasugrel, or ticagrelor) separately inhibit the c (COX-1) and the adenosine diphosphate–dependent pathways, and together confer greater protection against platelet activation and stent thrombosis than either antagonist alone. Unfortunately, DAPT approximately doubles the risk of gastrointestinal (GI) bleeding compared with si...
2022-01-3106 minStar Update Podcast - Cardiology News Summaries2021 Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice GuidelinesThe 3 topic is on the top 10 messages we should know about the American College of Cardiology (ACC)/American Heart Association (AHA)/Society for Cardiovascular Angiography and Interventions 2021 coronary artery revascularization guideline
Top 10 Take-Home Messages
1. Treatment decisions regarding coronary revascularization in patients with coronary artery disease (CAD) should be based on clinical indications, regardless of sex, race, or ethnicity,
2. In patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended.
3. For patients with significant left main disease, surgical revascularization is indicated...
2022-01-3103 minStar Update Podcast - Cardiology News SummariesReal World Analysis of Effectiveness and Safety of Apixaban Versus Warfarin in Obese Patients with Nonvalvular Atrial Fibrillation- a RWEAs we have seen so far Real-world studies have evaluated the use of anticoagulants in obese patients with nonvalvular atrial fibrillation (NVAF), but they have been limited by sample size or the use of diagnosis codes on claims to define obesity.
In a retrospective study of 26,522 NVAF patients with body weight of ≥100 kg or a body mass index of ≥30 kg/m2 , were enrolled from Veterans Affairs and fee-for-service Medicare system.
The study evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) in patients that were initiated on apixaban or warfarin.
After...
2022-01-3102 min
Star Update Podcast - Cardiology News SummariesAssociation of Lipoprotein(a) With Atherosclerotic Plaque ProgressionLipoprotein (a) [Lp (a)] is associated with an increased risk of myocardial infarction, although the mechanism for this observation remains uncertain.
Objectives
A study was conducted to investigate whether Lp(a) is associated with adverse plaque progression.
Methods
In this study Lp(a) was measured in patients with advanced stable coronary artery disease undergoing coronary CT angiography at baseline and 12 months to assess progression of total, calcific, noncalcific, and low-attenuation plaque (necrotic core) in particular. High Lp(a) was defined as Lp(a) ≥ 70 mg/dL.
The relationship of Lp(a...
2022-01-3102 minStar Update Podcast - Cardiology News SummariesEffect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic CardiomyopathyBackground: EXPLORER-HCM demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM).
Objectives: The purpose of this study was to evaluate mavacamten's effect on measures of cardiac structure and function and its association with changes in other clinical measures.
Methods: Key echocardiographic parameters from serial echocardiograms over 30 weeks were analyzed from 251 symptomatic obstructive hypertrophic cardiomyopathy (oHCM). patients out of which 123 were on mavacamten and 128 were on placebo [n = 128])
Results: More patients on mavacamten (80.9%; n = 76 of 94) vs placebo (34.0%; n = 33...
2021-12-3103 minStar Update Podcast - Cardiology News SummariesRandomized Trial of Metoprolol in Patients with Obstructive Hypertrophic CardiomyopathyBackground: The use of β-adrenergic receptor blocking agents in symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) rests on clinical experience and observational cohort studies.
Objectives: This study aimed to investigate the effects of metoprolol on left ventricular outflow tract (LVOT) obstruction, symptoms, and exercise capacity in patients with obstructive hypertrophic cardiomyopathy.
In this double-blind, placebo-controlled, randomized crossover trial 29 patients with obstructive HCM and New York Heart Association (NYHA) functional class II or higher symptoms from May 2018 to September 2020 were enrolled.
Patients received metoprolol or placebo for 2 consecutive 2-week periods in random order. The e...
2021-12-3103 minStar Update Podcast - Cardiology News SummariesDabigatran versus Warfarin on Cognitive Outcomes in Non- valvular Atrial Fibrillation: Results of the GIRAF Trial1. GIRAF trial was created with a multicenter, randomized, prospective parallel, active-controlled blinded design and conducted in 6 centers in Brazil., the trial assessed multiple cognitive outcomes in a cohort of patients randomized to 110 or 150 mg of dabigatran twice daily or once-daily warfarin.
2. The trial enrolled and randomized 200 patients. For inclusion in the trial, patients needed to have confirmed atrial fibrillation or atrial flutter, a CHA2DS2-VASc Score greater than 1, and be aged 70 years or older.
3. Exclusion criteria for the trial included a history of valvular heart disease, previous stroke, dementia or any severe neurological or...
2021-12-3103 minStar Update Podcast - Cardiology News SummariesAXIOMATIC-TKR Trial 1. The study randomized 1,242 patients undergoing knee arthroplasty to one of seven postoperative regimens of milvexian (25 mg, 50 mg, 100 mg, or 200 mg twice daily or 25 mg, 50 mg, or 200 mg once daily) or the anticoagulant enoxaparin (40 mg once daily). The primary efficacy outcome was venous thromboembolism, and the primary safety outcome was bleeding.
2. Results found that in those patients taking milvexian twice daily, venous thromboembolism developed in 21% population taking 25 mg, in 11% of the population taking 50 mg, in 9% population taking 100 mg, and in 8% of the population taking 200 mg.
3. Among those on the milvexian once-daily regimen, venous thromboembolism developed in 25% p...
2021-12-3103 minStar Update Podcast - Cardiology News SummariesEmpagliflozin in Patients Hospitalized for Acute Heart Failure – EMPULSE trialThe goal of the trial was to evaluate empagliflozin compared with placebo among patients with acute decompensated heart failure. Empagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor, which has been shown to reduce the risk of cardiovascular death or heart failure hospitalization among patients with chronic heart failure.
530 participants with acute heart failure were randomized to empagliflozin 10 mg daily versus placebo. Their mean age was 71 years, 47% were diabetics, and were followed for 90 days.
The participants had N-terminal pro–B-type natriuretic peptide (NT-proBNP) ≥1600 pg/ml or BNP ≥400 pg/ml during hospitalization or within 72 hours prior to admission, and th...
2021-12-0302 minStar Update Podcast - Cardiology News SummariesDaily Oral PCSK9 Inhibitor Encouraging in Phase 1 TrialsThe investigational PCSK9 inhibitor of Merck, MK-0616 — comes in pill form, in contrast to the three currently available PCSK9-lowering drugs that must be given in injections separated by weeks to months.
In two phase-1 studies with a total of 100 participants, MK-0616 was given daily for 2 weeks on a background of statin therapy for 14 days
The drug exhibited a dose-dependent increase in plasma exposure and > 90% mean maximum reduction of free plasma PCSK9 levels from baseline at all dose levels studied
At 14 days of treatment, participants receiving MK-0616 exhibited 65% reduction in the low-density-lipoprotein cholesterol (LD...
2021-12-0302 minStar Update Podcast - Cardiology News SummariesReal-World’ Prolonged DAPT Use Associated With Reduced Benefits, and Greater Harm Prolonged use of dual antiplatelet therapy (DAPT) following PCI may be associated with reduced benefits and greater harms in “real-world” clinical practice in contrast to outcomes of the DAPT Study
The study included 8,864 patients from the DAPT study and 568,540 registry patients. Longer-duration P2Y12 inhibitor therapy in the DAPT cohort was associated with a 1.01% decrease in-stent thrombosis, 1.9% decrease in major adverse cardiac and cerebrovascular events and a 2.27 decrease in MI but a 0.89% increase in moderate or severe bleeding.
The study concludes that longer-duration DAPT may have more limited benefits and greater harms when applied broadly in a...
2021-12-0301 minStar Update Podcast - Cardiology News SummariesRapid and Sustained Reversal of Ticagrelor–Intervention Trial called REVERSE-ITIn this trial, the safety and efficacy of bentracimab was assessed in reversing the antiplatelet effect of ticagrelor among patients needing urgent surgery or a procedure, or with major bleeding.
150 patients with a mean age of 65 years who either needed urgent surgery or a procedure or with major bleeding were enrolled in an open-label single-arm study.
On day 1, patients received an intravenous (IV) infusion of an initial IV bolus of 6 g infused over 10 minutes for rapid reversal, followed immediately by a 6 g IV loading infusion over 4 hours and then a 6 g IV maintenance infusion over 12...
2021-12-0303 minStar Update Podcast - Cardiology News SummariesBleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillationDirect oral anticoagulants have been evaluated in the general population, but proper evidence for their safe use in the geriatric population is lacking.
This study compared the bleeding risk of a direct oral anticoagulant (rivaroxaban) and vitamin K antagonists (VKAs) among French geriatric patients aged 80 years and above with non-valvular atrial fibrillation (AF)
In this sequential observational prospective cohort study, data from 33 geriatric centres comprised of 908 patients newly initiated on VKAs and 995 patients newly initiated on rivaroxaban.
They were followed up for up to 12 months, and risks of major, intracerebral, gastrointestinal bleedings, ischaemic...
2021-11-0202 minStar Update Podcast - Cardiology News SummariesDiuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trialThe role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial.
In this multicentre, double-blind trial, normotensive patients with intermediate-risk Pulmonary Embolism were randomized to receive either a single 80 mg bolus of furosemide or a placebo.
Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction.
The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all simplified PE Severity Index.
Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac ar...
2021-11-0202 minStar Update Podcast - Cardiology News SummariesTicagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBRPatients at high bleeding risk represent a prevalent subgroup among those undergoing percutaneous coronary intervention. Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy.
The aim of this study was to assess the effects of ticagrelor monotherapy in reducing the incidence of primary endpoint of 2, 3, or 5 BARC bleeding after 3-month dual antiplatelet therapy in a contemporary high bleeding risk population.
Event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor, after 3 months of ticagrelor plus aspirin.
At the end...
2021-11-0203 minStar Update Podcast - Cardiology News SummariesAssociation of Statin Therapy Initiation with Diabetes ProgressionStatin therapy has been associated with increased insulin resistance; however, its clinical implications for diabetes control among patients with diabetes is unknown.
To assess this, a large retrospective cohort study was conducted with 12 years data of 83, 022 propensity-scored matched pairs of statin users and nonusers covered by the US Department of Veterans Affairs from fiscal years 2003 to 2015.
Patients included were 30 years or older; diagnosed with diabetes during the study period; and were regular users of the Veterans Affairs health system, with records of demographic information, clinical encounters, vital signs, laboratory data, and medication usage.
...
2021-11-0202 minStar Update Podcast - Cardiology News SummariesMetoprolol in Critically Ill Patients With COVID-19Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting.
The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS.
Methods:
A total of 20 COVID-19 patients with ARDS on invasive mechanical ventilation were randomized to metoprolol (15 mg daily for 3 days) or control (no treatment). All patients underwent bronchoalveolar lavage (BAL) before and after...
2021-10-0402 minStar Update Podcast - Cardiology News SummariesFineronone improves CV outcomes in T2DM with CKD 2-4 stagesFinerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favorable effects on cardiorenal outcomes in patients with predominantly stage 3 or 4 chronic kidney disease (CKD) with severely elevated albuminuria and type 2 diabetes.
The use of finerenone in patients with type 2 diabetes and a wider range of CKD is unclear.
In this double-blind trial, patients with CKD and type 2 diabetes were randomized to receive finerenone or placebo.
Eligible patients of stage 2 to 4 CKD had a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 30 to less than 300 and an estimated glomerular...
2021-10-0403 minStar Update Podcast - Cardiology News SummariesTriglycerides and Residual Atherosclerotic Risk in participants with normal LDL-C levelsBackground:
Even when low-density lipoprotein-cholesterol (LDL-C) levels are lower than guideline thresholds, a residual risk of atherosclerosis remains. It is unknown whether triglyceride (TG) levels are associated with subclinical atherosclerosis and vascular inflammation regardless of LDL-C.
Objectives:
This study sought to assess the association between serum TG levels and early atherosclerosis and vascular inflammation in apparently healthy individuals.
Methods:
An observational, longitudinal, and prospective cohort study, was conducted in 3,754 middle-aged individuals with low to moderate cardiovascular risk from the study group called Progression of Early Subclinical Atherosclerosis who were...
2021-10-0403 minStar Update Podcast - Cardiology News SummariesAntihypertensives and Statin Therapy for Primary Stroke Prevention (A Secondary Analysis of the HOPE-3 Trial).Intro:
The HOPE-3 trial (Heart Outcomes Prevention Evaluation–3) found that antihypertensive therapy combined with a statin reduced the first stroke among people at intermediate cardiovascular risk.
In this study, secondary analyses of predefined stroke outcomes for each randomized intervention, was reported by stroke subtype, independent predictors, treatment effects in key subgroups, and absolute risk reductions.
Methods:
Using a 2-by-2 factorial design, 12 705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. Th...
2021-10-0403 minStar Update Podcast - Cardiology News SummariesHighlights of ESC Congress 2021: TOMAHAWK TrialIn a Hot Line session today, Professor Steffen (Germany) presented results from the large randomized, open-label TOMAHAWK trial, which undertook to provide a definitive position on the use of early angiography in patients with shockable or non-shockable rhythm.
The trial randomized 554 patients with return of spontaneous circulation after OUT OF HOSPITAL CARDIAC ARREST with no obvious extracardiac origin of cardiac arrest and no ST-segment elevation/left bundle-branch block on post-resuscitation electrocardiogram to either immediate coronary angiography or initial intensive care unit (ICU) assessment with delayed/selective angiography in a 1:1 ratio.
The primary endpoint was all-cause...
2021-09-0602 minStar Update Podcast - Cardiology News SummariesHighlights of ESC Congress 2021: STEP StudySTEP study, presented by Professor Jun Cai (Chinese Academy of Medical Sciences, Beijing, China) in a Hot Line session on 30th August.
The STEP study investigated whether intensive treatment (systolic blood pressure [SBP] target below 130 mmHg but no lower than 110 mmHg) could reduce the risk of cardiovascular (CV) events compared with standard treatment (SBP target 130–150 mmHg).
In total, 8,511 patients aged 60–80 years with SBP 140–190 mmHg during three screening visits or who were taking antihypertensive medication were randomized
The primary outcome was a composite of stroke, acute coronary syndrome (ACS), acute decompensated heart failure, coronary revasc...
2021-09-0602 minStar Update Podcast - Cardiology News SummariesHighlights of ESC Congress 2021: Master DAPTIn a Hot Line session of 28th August, Professor Marco from Switzerland presented results from the investigator-initiated, open-label MASTER DAPT trial comparing an abbreviated vs. a standard duration of antiplatelet therapy after bioresorbable polymer-coated sirolimus-eluting stent implantation in patients with acute or chronic coronary syndrome who fulfilled one or more high bleeding-risk criteria.
Following a mandatory 30-day DAPT run-in phase after percutaneous coronary intervention (PCI), eligible patients who were free from ischaemic and bleeding events were randomized 1:1 to receive abbreviated or standard DAPT.
Abbreviated treatment comprised single antiplatelet therapy until study completion, except for patients...
2021-09-0603 minStar Update Podcast - Cardiology News SummariesHighlights of ESC Congress 2021: Emperor Preserved HFResults from the EMPEROR-Preserved trial were presented by Professor Stefan from Berlin in a Hot Line session on 27th August. This international double-blind trial enrolled 5,988 symptomatic HFpEF patients (LVEF >40%) with and without T2DM who had elevated N-terminal pro-BNP concentrations (>300 pg/mL in patients without and >900 pg/mL in patients with atrial fibrillation) along with evidence of structural changes in the heart or documented history of HF hospitalization.
Participants were randomized 1:1 to receive empagliflozin 10 mg daily or placebo
The primary endpoint was a composite of CV death or hospitalization for HF.
The f...
2021-09-0603 minStar Update Podcast - Cardiology News SummariesDiabetes Duration Linked to Increasing Heart Failure RiskThis is a post hoc analysis of the ARIC study, with the objective to assess the association of diabetes duration with incident heart failure (HF).
In this study, 9,734 participants from the ARIC study with mean age of 63 years without HF or coronary heart disease were included and their diabetes duration at Visit 4 was taken as baseline.
After 22.5 years of follow up, it was found that,
1. Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk.
2. The HF and diabetes duration associations were stronger among...
2021-07-3102 minStar Update Podcast - Cardiology News SummariesMeta-Analysis of Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome Treated With Coronary StentingThis study was aimed to evaluate if a shorter course of Dual Anti-Platelet Therapy followed by P2Y12 inhibitor monotherapy is as effective as a 12-month course with fewer bleeding events.
Five randomized clinical trials were included, with a total of 18,046 participants.
Antiplatelet strategies compared were
· aspirin and P2Y12 inhibitor for 12 months
· aspirin and P2Y12 inhibitor for 1 to 3 months followed by P2Y12 inhibitor alone.
In the end of the study it was found that Patients randomized to 1 to 3 months of DAPT followed by P2Y12 inhibitor mo...
2021-07-3101 minStar Update Podcast - Cardiology News SummariesTotal Ischemic Event Reduction With Rivaroxaban After Peripheral Arterial Revascularization in the VOYAGER PAD TrialBackground: Patients with peripheral artery disease (PAD) undergoing Lower extremity revascularization (LER) are at high risk of major adverse limb and cardiovascular events.
The VOYAGER PAD trial demonstrated that rivaroxaban 2.5 mg twice daily reduced first events by 15%. The benefit of rivaroxaban on total (first and subsequent) events in this population are unknown.
The Objectives: of this study sought to evaluate the total burden of vascular events in patients with PAD after Lower extremity revascularization and the efficacy of low-dose rivaroxaban on total events.
Methods: In this study patients with PAD undergoing Lower extremity r...
2021-07-3103 minStar Update Podcast - Cardiology News SummariesHighlights of ESC HF 2021 - Insights from Augustus TrialEfficacy and Safety of Antithrombotic Strategies in Patients with Atrial Fibrillation and Recent ACS or PCI With and Without A History of Heart Failure: Insights From the AUGUSTUS Trial
The Augustus trial was done in AF patients with recent ACS or PCI, and Apixaban on the background of P2Y12 without aspirin resulted in less bleeding, few hospitalization,s and no significant difference in ischemic events compared to a regimen that included a Vitamin K Antagonist, aspirin or both.
Heart Failure is frequent in this population due to a prothrombotic state and is associated with...
2021-07-3103 minStar Update Podcast - Cardiology News SummariesHighlights of ESC HF 2021 - AFFIRM-AHF-based multinational cost-effectiveness analysis of intravenous ferric carboxymaltose for the treatment of iron deficiency in an acute heart failure settingAFFIRM-AHF-based multinational cost-effectiveness analysis of intravenous ferric carboxymaltose for the treatment of iron deficiency in an acute heart failure setting
Heart Failure utilizes major resources and is an economic burden on healthcare systems.
Iron deficiency is prevalent in 50% of patients with chronic HF and in 80% of patients hospitalized for acute HF. It is associated with poor functional status and increased risk of adverse outcomes in HF patients, thus Iron deficiency in HF is an area of significant unmet need.
In the AFFIRM-AHF trial, patients hospitalized for acute HF with LVEF
2021-07-0803 minStar Update Podcast - Cardiology News SummariesHighlights of ESC HF 2021 - Insights from the VICTORIA trial (VerICiguaT global study in subjects with HFrEF)Vericiguat in patients with atrial fibrillation and heart failure with reduced ejection fraction: Insights from the VICTORIA (VerICiguaT global study in subjects with HFrEF)
As we know, Heart failure is associated with impaired synthesis of Nitric Oxide and decreased activity of soluble Guanylate Cyclase (sGC), which may contribute to myocardial and vascular dysfunction. By directly stimulating soluble Guanylate Cyclase, independently of and synergistically with Nitric Oxide, Vericiguat augments levels of intracellular cGMP, leading to smooth muscle relaxation and vasodilation.
AF is a common arrhythmia involved with Heart Failure and complicating factor for HF with reduced e...
2021-07-0802 minStar Update Podcast - Cardiology News SummariesHighlights of ESC HF 2021 - Insights from the GALACTIC-HF TrialEfficacy of Omecamtiv mecabril in heart failure with reduced ejection fraction according to N-terminal pro-B-type natriuretic peptide level: Insights from the GALACTIC-HF trial.
The primary outcome of this trial was the time to first heart failure event or cardiovascular death, which occurred significantly less in patients randomized to Omecamtiv mecabril group.
In sub-analysis, the effect of Omecamtiv mecarbril on NT-pro BNP level, and pre-specified outcomes based on NT-pro BNP level i.e. < > median value i.e. 1675 pg/ml, and on continuous NT-pro BNP level were also evaluated
The result showed that Omecamtiv Mecarbril...
2021-07-0802 minStar Update Podcast - Cardiology News SummariesHighlights of ESC HF 2021 - Which Beta Blocker in HFmrEF?What is the evidence and which beta-blocker should a patient with HFmrEF receive?
Till Copernicus trial ejection fraction were used to define outcome of a trial, but now this clinical parameter is used to group individuals with Heart Failure that will yield different outcome to a given treatment.
In 2016, ESC Heart Failure guidelines classified and defined HF with reduced ejection fraction, HF with preserved ejection fraction, and HF with mid-range ejection fraction.
Studies like CHARM, I PRESERVE & TOPCAT were disappointment as they showed results with ARNI or RAAS inhibitors close...
2021-07-0802 minStar Update Podcast - Cardiology News SummariesPARADISE MIThe goal of the trial was to assess the efficacy and safety of sacubitril/valsartan compared with ramipril in a contemporary acute myocardial infarction (AMI)
IN THIS,
5,660 PATIENTS FROM 43 COUNTRIES
WITH MEAN AGE OF 64 YEARS
WITH PRIOR MI
WITH Left ventricular ejection fraction ≤40% with or without pulmonary congestion
WERE RANDOMIZED TO RECEIVE EITHER sacubitril/valsartan OR RAMIPRIL AND WERE FOLLOWED UP FOR 23 MONTHS.
THE RESULT OF THE TRIAL SHOWED THAT,
The primary outcomes of CV death or HF hospitalization were not statistically different be...
2021-05-3101 minStar Update Podcast - Cardiology News SummariesTHE ADAPTABLE STUDYIn this trial, 15,000 patients from 40 centers across the U.S. were self-enrolled and self-randomized between 2016 & 2019.
The Participants were of median age of 67 years
With 35.3% had a history of myocardial infarction (MI) and
53% had coronary revascularization within the previous five years.
The Results showed after median 26 months of follow-up were as follows
No significant difference in the primary effective outcome of all-cause death, MI, or stroke OR
Primary safety outcome of major bleeding requiring blood transfusion at 12 months.
But there was a high rate of dose...
2021-05-3101 minStar Update Podcast - Cardiology News SummariesATLANTISThe goal of the trial was to assess the efficacy and safety of Apixaban 5 mg BID compared with standard of care (antiplatelet therapy [APT] or oral anticoagulant [OAC]) among patients undergoing transcatheter aortic valve replacement commonly known as (TAVR).
In this study 1500 patients of mean age of 82 years, with 53% having a Self-expanding valve; 47% with balloon-expandable valve and 3% with valve-in-valve were included.
The trial was divided into 2 layers, in one stratum Apixaban was compared to standard Vitamin K Antagonist requiring Oral Anti-Coagulant therapy and in other stratum Apixaban was compared to standard Antiplatelet therapy (Single or...
2021-05-3103 minStar Update Podcast - Cardiology News SummariesLAAOS 3The goal of the trial was to evaluate surgical left atrial appendage occlusion compared with no occlusion among patients with atrial fibrillation undergoing open-heart surgery.
In this trial, 4770 patients on anticoagulation therapy for over 3 years with atrial fibrillation with CHA2DS2-VASc ≥2, were randomized to undergo open-heart surgery with or without left atrial appendage occlusion
In results:
The primary outcome of ischemic stroke or systemic embolism after 3.8 years occurred in 4.8% of the occlusion group compared with 7.0% of the no occlusion group with a significance of 0.001
In the Secondary outcomes, the event of...
2021-05-3101 minStar Update Podcast - Cardiology News SummariesThe Value of High-Sensitivity Troponin in the Era of COVID-19Studies have shown that patient with COVID-19 and underlying Cardiovascular disease were more likely to show raised cardiac Troponin-T and have a 70% risk of poor prognosis or early mortality, further data suggest that level of cardio biomarkers like myoglobin, NT-pro BNP was significantly higher in severe & critical cases versus mild cases. It was known that in Covid infections, cardiac morbidities like Myocarditis, Hypertensive crisis, CHF, and Myocardial infarction can cause marked elevation of Troponin T.
Thus it is can be concluded that Level of Troponin-T can help us in risk stratification, prognostication, and categorization of Covid cases.
2021-04-1901 minStar Update Podcast - Cardiology News SummariesDeath and MI following initial revascularization versus optimal medical therapy in chronic coronary syndrome: A systemic review & Meta-analysis of RCTRecently a meta-analysis was conducted on 7 randomized controlled trials of PCI or CABG plus Optimal Medical Therapy (OMT) versus OMT alone involving 10797 patients with chronic coronary syndromes
This is the first meta‐analysis to include patients with CCS and severely reduced left ventricular ejection fraction as well as those with CKD. This is the only meta‐analysis with documented myocardial ischemia and in which revascularization included both PCI and CABG.
After a follow-up of 5 years, it was found that initial revascularization with PCI or CABG plus OMT did not reduce long‐term mortality compared with OMT al...
2021-04-1902 minStar Update Podcast - Cardiology News SummariesMacitentan Triple combination therapy in Pulmonary Arterial Hypertension: Real World evidence from Opus RegistryTriple combination therapy, either initial or sequential is part of the recommendation in the ESC/ERS guidelines for the treatment of Pulmonary Arterial Hypertension (PAH). OPUS is a prospective, multicenter, observational drug registry of PAH patients newly initiated on macitentan. Recently, analysis was done on treatment patterns, outcomes, and safety for PAH patients receiving triple combination therapy comprising of macitentan plus a phosphodiesterase type 5 inhibitor (PDE5i) plus a prostacyclin pathway agent (any route) in OPUS from April 2014 to 2020.
In the study triple therapy was either initial (i.e. with no PAH therapy for over 60 days before...
2021-04-1902 minStar Update Podcast - Cardiology News SummariesThe Future of Aspirin Therapy in Cardiovascular DiseaseAspirin is an affordable, familiar, and most widely prescribed drug for acute and post cardiovascular events or revascularization procedures. It is also an essential member of dual antiplatelet therapy or DAPT (a P2Y12 inhibitor plus ASA) and dual pathway inhibition or DPI (Rivaroxaban plus ASA), and data for both combinations are increasing.
Gastrointestinal bleeding is the most common adverse event associated with Aspirin therapy, the COGENT trial has shown that prophylactic PPI agents reduced this risk in Clopidogrel plus Aspirin DAPT therapy. Recently, phospholipid-coated formulation of ASA has been studied in comparison to regular uncoated ASA...
2021-04-1902 min