Preventive Cardiology as a Subspecialty of Cardiovascular Medicine: JACC Council Perspectives
Perspective | By MD Shapiro, DJ Maron, PB Morris et al.
Although significant progress has been made to reduce the global burden of cardiovascular disease, efforts have focused primarily on treatment of manifest disease rather than on prevention of events. An enormous opportunity exists to transition focus from intervention to providing equal attention to prevention of cardiovascular disease. The nascent specialty of “preventive cardiology” is emerging from the background of long-establis...
Review Article | By A Mangieri, C Montalto, E Poletti et al.
A large amount of evidence supports the widespread use of transcatheter aortic valve replacement (TAVR) among patients who are at low to intermediate risk for surgery. However, several controversies exist about the optimal antithrombotic regimen to use in these patients. On the one hand, concerns about ischemic stroke, subclinical leaflet thrombosis, valve thrombosis, and long-term durability suggest the need for a stronger antithrombotic...
Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Multivessel PCI
Original Research | By K Takahashi, PW Serruys, P Chichareont et al.
BACKGROUND - Data on optimal antiplatelet treatment regimens in patients who undergo multivessel percutaneous coronary intervention (PCI) are sparse. OBJECTIVES - This post hoc study investigated the impact of an experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) versus a reference regimen (12-month DAPT followed by 12-mon...
Original Research | By KK Lee, AV Ferry, the High-STEACS Investigators.
BACKGROUND - Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. OBJECTIVES - The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome. ...
Individualizing Revascularization Strategy for Diabetic Patients With Multivessel Coronary Disease
Original Research | By M Qintar, KH Humphries, JE Park et al.
BACKGROUND - In patients with diabetes and multivessel coronary artery disease (CAD), the FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial demonstrated that, on average, coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) for major acute cardiovascular events (MACE) and angina reduction. Nonet...
Nonproportional Hazards for Time-to-Event Outcomes in Clinical Trials: JACC Review Topic of the Week
| By J Gregson, L Sharples, GW Stone et al.
Most major clinical trials in cardiology report time-to-event outcomes using the Cox proportional hazards model so that a treatment effect is estimated as the hazard ratio between groups, accompanied by its 95% confidence interval and a log-rank p value. But nonproportionality of hazards (non-PH) over time occurs quite often, making alternative analysis strategies appropriate. This review presents real examples of cardiology t...
Clinical Trial | By Thuijs DJFM, Kappetein AP, SYNTAX Extended Survival Investigators.
BACKGROUND - The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. ...
Original Research | By Morrow DA, Velazquez EJ, DeVore AD et al.
Original Research | By CH Kim, B-K Koo, H-M Dehbi et al.
OBJECTIVES - This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. BACKGROUND - An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. METHODS - T...
Risk of Mortality Following Catheter Ablation of Atrial Fibrillation
Original Research | By EP Cheng, CF Liu, JW Cheung et al.
BACKGROUND - Although procedure-related deaths during index admission following catheter ablation of AF have been reported to be low, adverse outcomes can occur after discharge. There are limited data on mortality early after AF ablation. OBJECTIVES - This study aimed to identify rates, trends, and predictors of early mortality post-atrial fibrillation (AF) ablation. METHO...