Similar Outcomes with Bivalirudin and Unfractionated Heparin During PCI for Acute Coronary Syndromes

Approximately two-thirds of all PCI are performed for acute coronary syndromes.  In this setting, the optimal balance of anticoagulation to avoid thrombosis against the risk of major bleeding is a pivotal area of procedural management.  Multiple clinical trials have compared bivalirudin and heparin (+/- IIb/IIIa inhibitor), but the optimal strategy remains debated.  In particular, changes […]

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The Natural History of Takotsubo Cardiomyopathy

In the 25 years since first being described, takotsubo (stress) cardiomyopathy has gained increasing recognition as a common clinical entity.  Despite this, our understanding of the natural history of takotsubo cardiomyopathy remains limited.  The International Takotsubo Registry has been gathering data on takotsubo cases since 1998 and this publication describes their findings to date.  Among […]

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Adaptive servo-ventilation increases mortality in systolic heart failure

Central sleep-apnea (CSA) with associated Cheyne-Stokes breathing patterns effects up to 40% of patients with low ejection fraction heart failure.   Given that CSA is an independent marker for poor prognosis and mortality, treatment of CSA has been identified as a potential target to improve heart failure outcomes.  This study randomized 1325 patients with low ejection […]

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Empagliflozin reduces cardiovascular mortality in Type 2 Diabetics

The prevalence of type 2 diabetes is increasing rapidly and represents a major risk factor for cardiovascular disease.  Although glycemic control has been shown to reduce microvascular complications, the effect of glycemic control on macrovascular disease is more limited.  Furthermore, some glucose lowering drugs have been associated with worse cardiovascular outcomes.  Accordingly, ensuring the cardiovascular […]

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Revascularization in response to identification of elevated high sensitivity troponin in stable patients does not improve outcomes

Among patients presenting with an acute coronary syndrome, cardiac troponin assays are the standard method for the identification of patients at high risk who benefit from early revascularization.  With advances in technology, high-sensitivity troponin (hsTn) assays are now available to identify levels of circulating troponin that were previously undetectable.  In this study, the authors sought […]

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Leadless pacemakers demonstrate promise

Approximately 10% of patients who receive a pacemaker experience complications related to the use of transvenous leads, the surgical pocket, or the pulse generator.  A leadless pacemaker inserted in the right ventricle by way of a transvenous catheter may result in lower complication rates. These leadless pacemakers include electronics, battery, and electrodes all in a […]

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A reversal agent for dabigatran

Unlike warfarin, non-vitamin K antagonist oral anticoagulants lack reversal agents for administration in the case of severe bleeding or perioperative management. Idarucizumab is a monoclonal antibody fragment that was developed to reverse the anticoagulant effects of the direct thrombin inhibitor dabigatran.  In this safety and efficacy study, idarucizumab was tested in a cohort of patients […]

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Testosterone Therapy: No Impact on Atherosclerosis…and No Improvements in Health

For men with age-related decline in testosterone levels, there is significant controversy over the risks and benefits of testosterone supplementation.  Despite a paucity of data, testosterone sales have increased markedly in the past decade.  The Testosterone’s Effects on Atherosclerosis Progression in Aging Men (TEAAM) Trial evaluated the impact of increasing testosterone concentrations on progression of […]

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Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Clinical Evaluation of Chest Pain Admissions

Chest pain concerning for a coronary syndrome leads to millions of hospital admissions each year that is often evaluated with diagnostic testing.  As a noninvasive diagnostic study, coronary computed tomography angiography (CCTA) has been shown to have excellent diagnostic capabilities.  However, concerns over CCTA remain, including radiation exposure, false-positives, and trials of the diagnostic modality […]

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