Low-Gradient Severe Aortic Stenosis with Preserved Left Ventricular Function: A New Disease?

An analysis of prospective data helps to elucidate the characteristics and course of a common, clinically distinct form of AS.

In a randomized trial, a radial approach by experienced operators was similar in efficacy to a femoral approach and resulted in a lower rate of vascular complications.

Findings from small trials and observational studies suggest that rates of vascular and bleeding complications of percutaneous coronary intervention (PCI) are lower with radial than with femoral arterial access. In a randomized, unblinded trial at 158 hospitals in 32 countries, investigators assigned 7021 patients (mean age, 62; 14% aged >75) with acute coronary syndromes (28% ST-segment-elevation myocardial infarction [STEMI]) to either radial or femoral access for coronary angiography and planned PCI between 2006 and 2010.

Evidence-Based Therapies for ST-Segment-Elevation Myocardial Infarction Improve Survival

A national registry in Sweden captures comprehensive data on the evolution of STEMI treatment and outcomes.

Several reports have described trends in therapy and outcomes in patients with myocardial infarction (MI), but few have included unrestricted populations. This study focuses on trends in evidence-based therapies and mortality in 61,238 patients who had a first-time diagnosis of ST-segment-elevation MI (STEMI) at acute cardiac care hospitals throughout Sweden from 1996 through 2007.

Erythropoietin Does Not Reduce Infarct Size in ST-Segment-Elevation Myocardial Infarction

In REVEAL, not only was epoetin alfa of no benefit, a suggestion of harm was seen in patients older than 70.

Myocardial Injury Associated with Transcatheter Aortic Valve Implantation

Most patients have elevated cardiac enzyme markers after uncomplicated TAVI, but higher levels may be associated with worse outcomes.

Little is known about adverse myocardial effects of transcatheter aortic valve implantation (TAVI), which may arise from hypotension (due to balloon valvuloplasty or rapid pacing), tissue compression during deployment, or ventricular puncture during transapical access. In this single-center Canadian study, investigators measured cardiac enzymes at multiple time points up to 72 hours after TAVI of a balloon-expandable prosthesis in 101 patients, 63 of whom had transapical access. Patients who died within 24 hours or had life-threatening procedural complications were excluded from the analysis.

Cardiac Rehabilitation After Percutaneous Coronary Intervention Reduces Mortality

So why are fewer than half of PCI recipients being referred?

Okay to Switch from Heparin to Bivalirudin Before Primary Percutaneous Coronary Intervention

In patients taking unfractionated heparin at baseline, those who switched did as well as — or better than — those who remained on UFH with an added glycoprotein IIb/IIIa inhibitor.

In the industry-sponsored HORIZONS-AMI trial, investigators compared bivalirudin with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibition for antithrombosis during primary percutaneous coronary intervention (PCI; JW Cardiol May 21 2008). In this subanalysis, the effects of switching agents were assessed in the 2357 patients who had received UFH before randomization. Most (82%) received bolus-only UFH (about 5000 IU, on average) about 1 hour before study drug administration.

Pocket Mobile Echocardiography: Balance Promise with Prudence

Compared with standard transthoracic echocardiography, a pocket device performed well on some measures, but its role in clinical practice is still evolving.

Registry data show that the rate of late PCI on completely occluded arteries did not decline after the OAT findings prompted guideline recommendations against it.

The 2006 Occluded Artery Trial (OAT) demonstrated no benefit of percutaneous coronary intervention (PCI) to treat completely occluded culprit arteries >24 hours after acute myocardial infarction (MI; JW Cardiol Nov 14 2006).

Consequently, the 2007 American College of Cardiology/American Heart Association guidelines for ST-segment-elevation MI (STEMI), non-STEMI, and PCI include class III recommendations against such treatment. To what extent have the OAT results and the guideline recommendations been incorporated into practice?

Ticagrelor Trumps Clopidogrel in ACS Patients Slated for Noninvasive Management

The results of yet another prespecified subgroup analysis mimic those of the larger trial.

Note: Ticagrelor has now been approved by the FDA for marketing in the U.S. For a discussion of the response to this approval in the cardiology community, see the recent Voices blog on CardioExchange, an online forum for cardiology news and discussion.