As we count down to CRT 201,7 let's look back through the years. We hope to see you at this years' at CRT 2017!
View Highlights from the past CRT 2016. Hope to see you at CRT 2017.
Biomarkers for identification of patients with adult congenital heart disease (ACHD) who are at high risk of cardiovascular events have not been explored. In a study of 595 patients with ACHD, NT-proBNP in the upper quartile was associated cardiovascular events and with death or heart failure. Elevated NT-proBNP, elevated hs-toponin-T, and elevated growth-differentiation factor 15 identified patients at the highest risk of cardiovascular events.
Left atrial appendage (LAA) closure has been approved as an alternative to warfarin for stroke prevention in patients with AF. Analysis of 3,822 cases undertaken in US centres following FDA approval has indicated 95.6% success rate. Complication rates included pericardial tamponade at 1.02%, procedure related stroke at 0.078%, device embolization at 0.24%, and procedure related death at 0.078%.
The efficacy of percutaneous mechanical circulatory devices in reducing mortality in patients with cardiogenic shock has remained suboptimal. A randomized study comparing a new such device (Impella CP, Abiomed, Danvers, Massachusetts) with an intra-aortic balloon pump in patients with severe shock complicating acute MI has shown similar rates of 30-day and 6-month mortality.
The optimal antiplatelet therapy in patients who have undergone revascularization for peripheral arterial disease (PAD) is unknown. Results from the EUCLID study in which such patients were randomizes to either clopidogrel or ticagrelor has demonstrated similar rates of all-cause mortality, acute limb ischemia, or major bleeding over a median follow-up period of 30 months.
Routine thrombectomy in patients presenting with STEMI has remained controversial in light of recent randomized data. An individual patient based meta-analysis of the three randomized studies (TAPA, TASTE, and TOTAL) has concluded that routine thrombus aspiration during PPCI does not improve clinical outcomes. In patients with high thrombus burden, a trend towards reduced cardiovascular death but increased stroke rate was observed.
The LEADERS FREE study confirmed the safety and efficacy of the BioFreedom Biolimus A9 drug coated stent using a 1-month dual antiplatelet therapy regime in patients with high risk of bleeding. 2-Year data from the study has indicated that the safety and efficacy of the drug coated stent was maintained with similar rates of major bleeding and coronary thrombotic events. Multivariate correlates of major bleeding were age >75 years, anemia, raised creatinine, and planned long-term anticoagulation.
Although tranexamic acid may reduce bleeding complications in patients undergoing cardiac surgery, it is uncertain if this translates into improved clinical outcomes. A randomized study of patients undergoing CABG who were at risk of perioperative complications to either aspirin or placebo and tranexamic acid or placebo has concluded that tranexamic acid reduced the risk of bleeding but was associated with an increased risk of postoperative seizures.
The safety and efficacy of Cangrelor in combination with glycoprotein IIb/IIIa inhibitors (GPIs) has not been addressed. Pooled, patient level analysis of the three CHAMPION studies suggests that the efficacy of Cangrelor in reducing ischemic complications in patients undergoing PCI was maintained regardless of GPI administration although bleeding complications were greater.
Nicole Lou Reporter, MedPage Today/CRTonline.org
F Bragg, et al.; JAMA 2017; 317:280-89
J Seitz, et al.; JACC 2017; 69:303-21
M Ohya, et al.; AHJ 2017; 119:355-364
M Abbas, et al.; Circ 2017; 135:280-296
J Kim et al.; Heart 2017; 103:219-26
Is there a role for embolic protection device in patients undergoing TAVR?
No role, without efficacy data
Role in selected group of patients
Role for every patient
CRT Group Foundation is a not for profit corporation dedicated to providing educational services in the field of cardiology through the website, CRTonline.org and the Cardiovascular Research Technologies (CRT) annual symposium. CRT focuses on the advances and changes in the field of cardiovascular medicine. CRT is designed to provide access to the world’s leading clinicians and the latest research in order to improve practice and treatment outcomes for a variety of health care professionals.