Star Update Podcast - Cardiology News Summaries

Ticagrelor monotherapy in ST-elevation myocardial infarction: An individual patient-level meta-analysis from TICO and T-PASS trials

Med. 2024 Aug 10:S2666-6340(24)00301-5.

 Abstract

Background: Patients with ST-elevation myocardial infarction (STEMI) tend to be excluded or under-represented in randomized clinical trials evaluating the effects of potent P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (DAPT).

 Methods: Individual patient data were pooled from randomized clinical trials that included ST-elevation myocardial infarction  STEMI patients undergoing drug-eluting stent (DES) implantation and compared ticagrelor monotherapy after short-term (≤3 months) short-term

 Findings: The pooled cohort contained 2,253 patients with ST-elevation myocardial infarction. The incidence of the primary efficacy outcome did not differ between the ticagrelor monotherapy group and the ticagrelor-based dual antiplatelet therapy group (1.8% versus 2.0%; hazard ratio [HR] = 0.88; 95% confidence interval [CI] = 0.49-1.61; p = 0.684). There was no difference in cardiac death between the groups (0.6% versus 0.7%; HR = 0.89; 95% CI = 0.32-2.46; p = 0.822). The incidence of the primary safety outcome was significantly lower in the ticagrelor monotherapy group (2.3% versus 4.0%;

 Conclusions: In patients with ST-elevation

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Efficacy and Safety of P2Y12 monotherapy vs DAPT  in patients undergoing percutaneous coronary intervention: meta-analysis of randomized trials

Curr Probl Cardiol. 2024 Aug;49(8):102635. doi: 10.1016/j.cpcardiol.2024.102635

 Abstract

Background: Debates persist regarding the optimal duration of dual antiplatelet therapy (DAPT) after

 Methods: Multiple databases were searched. Six RCTs with a total of 24877 patients were included. The primary endpoint was all-cause mortality at 12 months of follow-up. The secondary endpoints were cardiovascular mortality, myocardial infarction, probable or definite

 Results: Monotherapy with P2Y12 inhibitor ticagrelor significantly reduced both all cause mortality (HR 0.71, 95 CI [0.55-0.91], P = 0.007) and cardiovascular mortality (HR 0.66, 95% CI [0.49-0.89], P = 0.006) compared to standard dual antiplatelet therapy  DAPT. In contrast, clopidogrel monotherapy did not demonstrate a similar reduction. The decrease in mortality associated with ticagrelor was primarily due to a lower risk of

 Conclusions: In comparison to standard dual antiplatelet therapy DAPT, P2Y12 inhibitor monotherapy with ticagrelor may lead to a reduced mortality. The clinical benefits are driven by a reduction of bleeding risk without ischemic risk trade-off.

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Early postoperative beta-blockers are associated with improved cardiac output after late complete repair of tetralogy of Fallot: a retrospective cohort study

Eur J Pediatr. 2024 Aug;183(8):3309-3317. doi: 10.1007/s00431-024-05597-1.

 Abstract

Tetralogy of Fallot is the most common cyanotic congenital heart disease. For decades, our institution has cared for humanitarian patients with late presentation of tetralogy of Fallot. They are characterized by severe right ventricular hypertrophy with consecutive diastolic dysfunction, increasing the risk of postoperative low cardiac output syndrome (LCOS). By right ventricular restrictive physiology, we hypothesized that patients receiving early postoperative beta-blockers (within 48 h after cardiopulmonary bypass) may have better diastolic function and cardiac output. This is a retrospective cohort study in a single-center tertiary pediatric

 Conclusion: Early postoperative beta-blockers lower the prevalence of postoperative low cardiac output syndrome at the expense of a higher need for vasoactive drugs without any consequence on length of stay and ventilation duration. This approach may benefit the specific population of children undergoing a late complete repair of tetralogy of Fallot.

What is Known: • Prevalence of low cardiac

What is New: • Early postoperative beta-blockade is associated with lower heart rate, prolonged relaxation time, and lower prevalence of low cardiac output syndrome. • Negative chronotropic agents like beta-blockers may benefit selected patients undergoing a late

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Eligibility and Projected Benefits of

JACC Heart Fail. 2024 Aug;12(8):1365-1377. doi: 10.1016/j.jchf.2024.03.001.

 Abstract

Background: U.S. nationwide estimates of the proportion of patients newly diagnosed with heart failure with reduced ejection fraction (HFrEF) eligible for quadruple medical therapy, and the associated benefits of rapid implementation, are not well characterized.

 Objectives: This study sought to characterize the degree to which patients newly diagnosed with heart failure with reduced ejection fraction (HFrEF) are eligible for quadruple medical therapy, and the projected benefits of in-hospital initiation.

 Methods: Among patients hospitalized

 Results: Of 33,036 patients newly diagnosed with heart failure with reduced ejection fraction (HFrEF), 27,158

 Conclusions: In this nationwide U.S. cohort of patients hospitalized for newly diagnosed heart failure with reduced ejection fraction (HFrEF), >4 of 5 patients were projected as eligible for quadruple therapy at discharge; yet, <1 in 6 were prescribed it. If clinical trial benefits can be fully realized, in-hospital initiation of quadruple

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any

Non-ST-elevation acute coronary syndromes

Eur Heart J . 2024 Jul 12;45(27):2380-2391.

 Abstract

Background and aims: A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE , Cochrane, and ClinicalTrials.gov. Eligible studies were randomized controlled trials of routine invasive vs. a conservative or selective invasive strategy in patients presenting with non-ST-elevation acute coronary syndromes that included patients with previous coronary artery bypass graft. Summary data were

 Results: Summary data were obtained from 11 randomized controlled trials, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477

 Conclusions: This is the first meta-analysis assessing the effect of a routine invasive strategy in patients

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Verification of haemoglobin level to prevent worsening of prognosis in heart failure with preserved ejection fraction patients from the PURSUIT-HFpEF registry

https://doi.org/10.1002/ehf2.14927

 Abstract

Aim

Anaemia has been reported as poor predictor

Methods and results

First, 547 heart failure with preserved ejection fraction cases were divided into two groups, Hb < 11.0 g/dL (n

 Conclusions

Change in haemoglobin after discharge using a

Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any

Ticagrelor downregulates the expression

Int J Cardiol . 2024 Jul 1:406:132073

 Abstract

Background: Platelet P2Y12 antagonist ticagrelor reduces cardiovascular mortality after acute myocardial

Objectives: We compared miR -125a, miR-125b and miR-223 expression in plasma of patients after AMI treated with ticagrelor or clopidogrel.

 Methods: After percutaneous coronary

 Results: Expression of miR-125b was higher in

 Conclusions: Ticagrelor treatment leads to lower plasma expression of miR-125b after acute myocardial infarction, compared to clopidogrel. Higher expression of miR-125b might explain recurrent thrombotic events and worse clinical outcomes in patients treated with clopidogrel, compared to ticagrelor.

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Clinical Pharmacogenetics Implementation

Clin Pharmacol Ther. 2024 Jul 1. doi: 10.1002/cpt.3351

Abstract

Beta-blockers are widely used medications for

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The new ESC acute coronary syndrome guideline and its impact in the CPU and emergency department setting

Herz. 2024 Jun;49(3):185-189. doi: 10.1007/s00059-024-05241-6

The new guideline on acute coronary syndrome (ACS) of the European Society of Cardiology (ESC) replaces two

1. New procedural approach as "think acute coronary syndrome" meaning "abnormal ECG," "clinical

2. New recommendation regarding a holistic approach for frail patients

3. Revised recommendations regarding

4- Revised recommendations for antiplatelet and anticoagulant therapy in ST-elevation myocardial infarction

5. Revised recommendations for cardiac arrest and out-of-hospital cardiac arrest

6. Revised recommendations for in-hospital management (starting in the CPU/ED ) and acute coronary syndrome comorbid conditions.

In summary, the changes are mostly gradual

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Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction

J Am Coll Cardiol. 2024 Jun 4;83(22):2135-2144

 Abstract

Background: Total coronary

 Objectives: We aimed to investigate

 Methods: In this secondary analysis

 Results: Increased 18F-sodium fluoride uptake was found in 679 of 2,094 coronary arteries and 414 of 691

 Conclusions: In patients with recent

 Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any