Clinicians often dichotomize coronary artery disease (CAD) on the basis of obstruction to blood flow given the implications of this threshold on considerations for revascularization. As a result, nonobstructive CAD is often characterized as less significant, although this may oversimplify the risks associated with nonobstructive disease. In this retrospective cohort of patients who underwent elective […]
Category: General cardiology
Gene mutation reduces risk of coronary disease
Niemann-Pick C1-like 1 (NPC1L1) protein is expressed in the small intestine and liver and facilitates the transport of intraluminal dietary cholesterol into enterocytes. This transporter is the target of the drug ezetimibe and inhibition of the transporter is known to significantly reduce plasma levels of LDL cholesterol. In this genetic study, the authors first sequenced […]
Outcomes with increased length of dual antiplatelet therapy after PCI
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. Although observational studies have suggested DAPT for longer than a year post-PCI reduces ischemic events, other studies suggest longer durations of DAPT confer no benefits despite increased bleeding risk. This randomized controlled trial evaluated patient outcomes with 12-months vs 30-months […]
Long-term outcomes of mechanical versus bioprosthetic aortic valve replacement in younger adults
Younger adults requiring aortic valve replacement often receive a mechanical valve given concerns over durability of bioprosthetic valves. However, prior studies have been underpowered to compare long-term survival implications of mechanical versus bioprosthetic valve replacement in younger adults. In this retrospective cohort from the New York Statewide Planning and Research Cooperative System (SPARCS) , 4253 […]
Ivabradine ineffective as add-on therapy for stable ischemic heart disease
Ivabradine reduces heart rate without affecting blood pressure or left ventricular systolic performance. Given studies demonstrating a relationship between heart rate and cardiovascular risk, modifying heart rate with ivabradine may reduce risk in patients with coronary disease. In the Study Assessing the Morbidity–Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease […]
Long-term benefit with blood pressure control, but not tight glucose control, in established type 2 diabetics
Prior studies of type 1 diabetics and newly diagnosed type 2 diabetics have suggested long-term reduction in mortality and macrovascular event risk resulting from earlier periods of tight glucose control. In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, blood pressure control in patients with type 2 […]
Trends in the Use of Stress Testing in the United States
Stress testing is a cornerstone in the evaluation of patients with possible symptoms of ischemic heart disease. The use of stress tests, and stress tests with imaging in particular, has increased over time raising concerns for inappropriate use that may include screening stress tests in asymptomatic patients. This study evaluated trends in the use of […]
Risks and Benefits of Percutaneous Coronary Interventions in Stable Coronary Disease: A Qualitative Analysis of Cardiologists’ Bedside Discussions
Although the benefits of PCI for stable CAD are limited to symptom reduction, prior studies have shown that patients often believe PCI for stable coronary artery disease (CAD) will mitigate the future risks of myocardial infarction or death. This study examined discussions between cardiologists and patients regarding angiograms and PCI in stable CAD to identify […]
Quality of Life following Coronary Artery Bypass Graft Surgery versus Guideline-based Medical Therapy in Ischemic Cardiomyopathy
It remains uncertain if surgical revascularization improves patient outcomes in the setting of coronary artery disease with reduced systolic function. This is particularly true in light of the STICH trial, a contemporary randomized control trial of coronary artery bypass graft surgery (CABG) with optimal medical therapy compared to optimal medical therapy alone in patients with […]
Beta-blockers in heart failure – what is the impact of concurrent atrial fibrillation?
Beta-blockers form an essential cornerstone of therapy for heart failure with reduced ejection fraction. However, the benefits of beta-blockade for heart failure in patients with concurrent atrial fibrillation are less certain. In this meta-analysis of individual-patient data from 10 randomized control trials comparing beta-blockers to placebo for systolic heart failure, investigators assessed the impact of […]