Although prior studies of screening for coronary artery disease (CAD) in high-risk patients have failed to demonstrate benefit, screening with cardiac coronary computed tomography (CCTA) may hold promise by providing more detail on the extent of coronary atherosclerosis. This trial randomized 900 patients with a 3 to 5 years history of type 1 or 2 […]
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The SAFETY Clinical Trial: Intensive Outpatient Follow-up to Improve Outcomes after Hospitalization for Atrial Fibrillation
The prevalence of atrial fibrillation (AF) is increasing with a concurrent rise in the number of hospitalizations for AF. The standard versus atrial fibrillation-specific management strategy (SAFETY) trial sought to test a nurse-led intervention following hospital discharge for chronic, non-valvular AF on patient outcomes of unplanned admission or all-cause death. Participants in the intervention arm […]
Why is Atherosclerotic Cardiovascular Disease Risk Overestimated by the ACC/AHA Pooled Cohort Equation?
The 2013 ACC/AHA Cholesterol Guidelines expand the recommendations for statin use to populations previously felt to be at lower risk. Central to risk-estimation in these guidelines is a new equation for determination of atherosclerotic cardiovascular disease (ASCVD) risk. However, this risk model has been criticized overestimating ASCVD risk in validation studies of the model. Using […]
Left atrial appendage closure in atrial fibrillation – is a comparison against warfarin still meaningful?
The majority of patients with nonvalvular atrial fibrillation (AF) have an indication for anti-coagulation to reduce the risk of stroke. As the left atrial appendage (LAA) is thought to the be the predominant source of thromboembolic events in the setting of AF, LAA closure may provide an alternative to anti-coagulation for stroke risk reduction without […]
The spectrum of coronary artery disease and risk of myocardial infarction
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 […]
Temporal trends towards increased mortality despite Improved door-to-balloon times in ST-elevation myocardial infarction
A short door-to-balloon time (D2B) is considered a quality of care measure for patients of ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (pPCI). However, recent literature has documented reductions in D2B that were not associated with improved STEMI mortality. Using the National Cardiovascular Data Registry (NCDR) CathPCI Registry, Nallamothu et al. assessed this apparent […]
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 […]