The target systolic blood pressure (SBP) in patients with an acute hypertensive response following intracerebral hemorrhage is unknown. The ATACH-2 trial investigators compared SBP target of 110-139 mmHg with 140-179 mmHg and have indicated that a target of 110-139 mmHg does not result in lower rates of death or disability. This study was terminated early because of futility after a pre-specified interim analysis.
Atrial fibrillation (AF) is associated with significant morbidity and mortality. A prospective registry of patients from 47 countries, with patients from North America, Western Europe and Australia serving as the reference population, has indicated that twice as many patients had died by 1 year from the onset of AF in South America and Africa as compared to the reference population. Heart Failure was the most common cause of death whilst stroke accounted for 8% of deaths. Stroke was greatest in Africa, China and Southeast Asia, and lowest in India.
There is currently no prediction model of sudden cardiac death (SCD) in the general population. Data from the ARIC Study and CHS has identified 12 independent risk factors including age, male sex, black race, smoking, systolic blood pressure, use of antihypertensive medication, DM, serum potassium, serum albumin, HDL, GFR and corrected QT interval as predictors of SCD in individuals free of baseline cardiovascular disease.
Neurological injury remains a major cause of morbidity and mortality in survivors of out-of-hospital-cardiac arrest (OOHCA). The RINSE Trial examined the utility of rapid infusion of cold saline to induce mild hypothermia in this population and demonstrated that the technique may decrease the rate of return of spontaneous circulation in patients with an initial shockable rhythm.
The risk of coronary events following an ACS in patients with familial hypercholesterolemia (FH) is not known. A multicenter, prospective study of 4534 patients has shown that as compared to patients without FH, patients with FH and ACS have a >2x fold adjusted risk of coronary event recurrence within the first year after discharge despite the use of high-dose statins.
The optimal revascularization strategy in patients with multivessel coronary artery disease (MVD) presenting with a STEMI has not been clearly defined. A meta-analysis of 32 studies has indicated that staged MV-PCI is associated with lower short-term and long-term mortality compared with infarct-related artery (IRA) only PCI and single stage MV-PCI. IRA-only PCI was associated with lower mortality compared with single stage MV-PCI.
The clinical outcomes of TAVR in bicuspid aortic stenosis have not been adequately examined. An international multicenter registry of 301 patients receiving early and new generation devices has indicated low risks of stroke, bleeding, major vascular complications, and kidney injury. New generation devices had no moderate or severe paravalvular leaks. Early safety endpoints and 30-day all-cause mortality were similar amongst early and new generation devices.
The cardiovascular impact of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) is unknown. A randomized study of 2717 patients with moderate to severe OSA has demonstrated that CPAP therapy plus usual care does not prevent the primary composite end point of death from CV causes, MI, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack.
Unprotected left main revascularization has remained the holly grail of PCI. A patient-level pooled analysis of two studies including 1,305 patients has indicated that at 5 years follow-up, CABG is associated with a lower rate of MACE compared to PCI. This difference was driven by higher rates of repeat revascularization in patients undergoing PCI. The two strategies had similar rates of death, MI or stroke. In patients with isolated left main disease or left main disease plus 1 disease vessel, PCI was associated a 60% reduction in all-cause mortality and 67% reduction in cardiac mortality as compared to CABG.
A number of studies have highlighted the benefit of CABG as the revascularization of choice in type 2 diabetic patients. A patient-level pooled analysis of three studies including 5,034 patients has confirmed that CABG plus optimal medical therapy (OMT) is superior to PCI+OMT over a median follow-up period of 4.5 years for the primary endpoint of death and MI but not stroke.
Nicole Lou Reporter, MedPage Today/CRTonline.org
S Sinha, et al.; JACC 2016; 68:1255-1264
Y Fan, et al.; JACC 2016; 68:1281-1293
R Collins, et al.; The Lancet Online
R Deo, et al.; Circ 2016; 134:806-816
M Clavel, et al.; JACC 2016; 68:1297-1307
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