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The choice for the type of transcatheter heart valve (THV) for failed surgical aortic bioprosthesis is uncertain. Data from the Valve-in-Valve International Data Registry comparing the St Jude Medical Portico (n=54) with the Medtronic Corevalve (n=108) has indicated that post implantation, the CoreValve was associated with larger effective orifice area, lower mean gradient, and lower moderate-to-severe aortic insufficiency. Survival and stroke rates at 30 days were similar between the two THV, but overall 1-year mortality was lower with the CoreValve.
Bococizumab, a humanized monoclonal antibody, has been shown to reduce LDL cholesterol. Two parallel, multinational studies including 27,438 patients have shown shown that this agent had no benefit upon MACE in lower-risk patients but had a significant benefit in higher-risk patients. However, further development of Bococizumab has been stopped in part due to the development of antidrug antibodies.
There is limited data regarding the efficacy of different stents in patients undergoing PCI for saphenous vein graft stenosis. Data from the British Cardiovascular Intervention Society including 15,003 such patients who had received bare-metal stents (BMS) (38%), first-generation DES (15%) or newer generation DES (47%) has indicated that rates of in-hospital MACE was significantly lower in patients receiving newer generation DES. 30-day and 1-year mortality were also lower in the newer generation DES, but not in first generation DES, compared with BMS-treated patients.
The SYNTAX study demonstrated improved long-term outcomes with CABG in patients with 3-vessel or left main coronary artery disease. 5-yeat follow-up data has indicated that CABG is superior to PCI on several SAQ domains including angina frequency and physical function particularly in patients with high SYNTAX scores.
PCSK9 is a key mediator of LDL metabolism. A phase 2, multicenter, double-blind, placebo-controlled trial of inclisiran, a small interfering RNA designed against PCSK9 messenger RNA, has been shown to result in sustained reductions in PCSK9 and LDL cholesterol amongst patients at high cardiovascular risk.
The association amongst bleeding, mortality, and duration of dual anti-platelet therapy (DAPT) following DES implantation remains debatable. A meta-analysis of 12 studies has indicated that patients with bleeding had significantly higher rates of mortality than those without. Bleeding was an independent predictor of mortality occurring within 1 year of the bleeding. As compared to longer DAPT duration, Shorter DAPT was associated with lower rates of all-cause death.
Endovascular therapy for ischemic stroke may lead to superior functional outcomes as compared with conventional medical therapy. 2-year outcomes from the MR CLEAN trial of 500 patients has indicated that endovascular therapy is associated with better modified Rankin scale and quality of life score but similar mortality rate to conventional medical therapy.
Nicole Lou, Reporter, MedPage Today/CRTonline.org
Crystal Phend Senior Associate Editor, MedPage Today
Nicole Lou Reporter, MedPage Today/CRTonline.org
Molly Walker Staff Writer, MedPage Today
Larry Husten CardioBrief
Salynn Boyles Contributing Writer
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N Pagidipati, et al.; JAMA 2017; 317:1563-67
J Boeddinghaus, et al.; Circ 2017; 135:1597-1611
B De Bruyne, et al.; Circ Cardiovasc Interv 2017; 10:e004719
P Ridker, et al.; NEJM 2017; 376:1517-26
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