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 […]
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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 […]
Dual Antiplatelet Therapy Beyond 1-year after Percutaneous Coronary Interventions for Stable Coronary Artery Disease Results in Harm
The benefit of extended dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. The ARTIC-Interruption Trial examined discontinuation of DAPT at 1-year after PCI vs continuation for an additional 6-18 months. The study randomized patients 1-year after PCI to continuation (N=635) or interruption (N=624) groups, and examined the primary composite endpoint of death, […]
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 […]
A new PARADIGM in heart failure treatment?
Natriuretic peptides are released in response to cardiac-wall stress and other stimuli of heart failure. These potent natriuretic and vasodilatory peptides also inhibit the renin-angiotensin system and sympathetic drive. The neutral endopeptidase neprilysin is responsible for the degradation of several of these natriuretic peptides. Inhibition of neprilysin increases the level of these natriuretic peptides, thus […]
No benefit to thrombus aspiration in STEMI
Thrombus aspiration in acute ST-segment elevation myocardial infarction (STEMI) is clinically appealing and often used prior to PCI. However, the majority of trials evaluating thrombus aspiration have failed to demonstrate significant mortality benefit. The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial is a multi-center study that randomized a total of 7244 presenting […]
Patient Understanding of Elective PCI Benefit Varies by Hospital
Elective percutaneous coronary intervention (PCI) does not prevent mortality or myocardial infarction, but is an important therapy for the relief of ischemic symptoms. However, a majority of patients believe that PCI for stable coronary artery disease (CAD) will prolong their lives and prevent heart attacks. In this study, investigators surveyed 991 patients undergoing elective PCI […]
Transcatheter aortic valve implantation – are we moving from equivalent to preferred in high-risk surgical patients?
Transcatheter aortic valve implantation (TAVI) has expanded the options for the treatment of severe aortic stenosis, particularly in patients for whom the surgical risk of valve replacement is felt to be prohibitive. Prior studies have demonstrated TAVI reduces mortality relative to medical management among patients unable to undergo valve surgery. Among patients considered to be […]