Apixaban for Treatment of Embolic Stroke of Undetermined Source (ATTICUS) Randomized Trial
Despite the significant frequency of covert atrial fibrillation, secondary prophylaxis with aspirin is the current standard therapy for ESUS (AF). The efficacy of apixaban in 353 ESUS patients (68.5 yrs old, 51% male) was evaluated. 130 and 120 subjects from apixaban & ASA arms, respectively, complete study. By far, apixaban has been found to be better.
Quadruple UltrA-low-dose Treatment for Hypertension - QUARTET
The author presented that starting with standard dose monotherapy is more successful than starting with quarter standard doses of four types of blood pressure reducing drugs. By 12 weeks, 15% of intervention and 40% of control had uptitrated. Despite increased up titration in the usual care group, quadpill had better BP management. Their BP was lower day and night.
TOMAHAWK: Immediate Angiography After Out-of-Hospital Cardiac Arrest
The 30-day risk of all-cause death was not reduced by rapid unselected coronary angiography in patients with resucitated OHCA of suspected cardiac origin, shockable or non-shockable arrest rhythm, and no ST-elevation. Trial COACT of solely OHCA patients with shockable arrest rhythms reported no difference in clinical outcome between immediate and delayed coronary angiography at 90 days and 1 year.
Association of Coronary Artery Calcium Score Groups With Adverse Plaque
In a multicenter clinical trial, the author demonstrated the initial viability of electrical pulmonary vein isolation (PVI), procedural execution, and acute safety. The InspIRE clinical trial was designed to assess the safety and efficacy of a fully integrated biphasic PFA system. However, 1 in 6 patients with stable chest pain has CAD.
DBP and cardiovascular events in atrial fibrillation individuals with SBP < 130 mm Hg
Secondary analysis of the SPRINT and ACCORD-BP trials showed DBP < 60 mm Hg was related with a 74% increase in CV outcome, whereas DBP between 70 and 80 mm Hg was associated with the nominally lowest risk. Because ventricular perfusion occurs largely during diastole, reduced DBP may cause hypoperfusion & myocardial injury. So lowering DBP too much may negate the benefits of lowering SBP.
Individualizing the target Diastolic BP in patients being treated for HTN and Diabetes
Heart disease is more common in diabetics with HTN. DBP commonly rises to about 70 mm Hg during treatment. This post-hoc analysis of ACCORD -BP revealed that intensive SBP lowering (120 mmHg) did not diminish the risk of the primary clinical objective. For patients with CVD and DM, the ideal DBP treatment target is slightly lower than the current guideline range of 70-80 mm Hg.
Diastolic Blood Pressure: Should we care
BP is closely linked to vascular and total mortality, with no evidence of a threshold below 115/75 mmHg. The author concluded that excessive diastolic hypotension combined with antihypertensive medication enhanced CAD risk. According to author, reperfusion removes risk at low diastolic BP. CAD blockage raises diastolic BP whereas revascularization lowers it.
Prasugrel or Clopidogrel in Patients with Acute Coronary Syndromes at High Thrombotic Risk
PROMETHEUS compared Prasugrel and Clopidogrel in ACS patients having PCI. ACS patients should take P2Y12 inhibitors in addition to aspirin.The best antithrombotic therapy should be altered based on the patient's thrombotic and hemorrhagic risk due to complications. Prasugrel, unlike Clopidogrel, reduced the risk of ischemia events in both high and low-to-moderate thrombotic risk patients.
Short-term Pulse Pressure Variability Linked to cardiovascular death among normotensive adults
Short-term systolic & diastolic blood pressure variability is linked to worse CVD outcomes, especially with established CVD risk factors. But data on short-term pulse pressure variability and mortality are scarce. The study monitored 6,340 normotensive adults (20+) for an average of 22.3 yrs. According to NHANES data, 2 visit pulse pressure variability is associated with cardiovascular death.
Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease
The study indicated that patients with an ACTA2 mutation had no myocardial dysfunction or arrhythmia. Patients with FBN1 and LDS gene variants had myocardial dysfunction. In patients with HTAD, myocardial dysfunction and arrhythmia are rare features. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not seen in patients carrying a variant in the ACTA2 gene.
Clinical Outcomes in COVID-19 Patients with In-hospital Cardiac Arrest
The study showed that critically sick patients with COVID-19 had high rate of cardiac arrest & poor effects in those who received CPR. A non-shockable initial rhythm designates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions.
Cardiovascular Protection by Combination of Finerenone and Empagliflozin
Non-steroidal MR antagonism with Finerenone and SGLT2 inhibition with Empagliflozin provide cardiovascular protection in preclinical hypertensive-induced cardiorenal disorder. Combination of these 2 modes of action at low dosages showed effectual decrease in blood pressure, cardiac lesions and mortality specifying a strong prospective for combined clinical usage in cardiorenal patient populations
Prof. Emeritus David Matthews (EASD 2019) - CANVAS program and CREDENCE trial
Prof. David Matthews discusses CANVAS and CREDENCE trials focusing on the use of SGLT2 inhibitor Canagliflozin in patients with incipient renal disease. Canagliflozin had significantly improve renal outcomes in the patients. However, amputation risk were different between the two trials. Canagliflozin was linked with increased amputation risk in the CANVAS Program but not in CREDENCE.
Multimodal Analgesic Management for Lumbar Decompression Surgery in the Ambulatory Setting
Largest ASC study examined lumbar decompression operations with no specific 23-hour surveillance (499 patients). It was found that lumbar decompression surgery can be performed in an ASC with proper patient selection, surgical technique, and multimodal analgesia. This treatment is safe in the ASC setting due to its low VAS and low postoperative complications.
Acute vs. Delaying Reverse Total Shoulder Arthroplasty Treatment of Proximal Humeral Fracture
This study aims to understand how the time of RTSA treatment influences results by comparing the revision rate, surgical and medical complications, and costs between acute and delayed RTSA. Delayed RTSA for proximal humeral fractures causes more 1-year revisions and dislocations than acute RTSA. Delaying RTSA may lead to more surgery and worse outcomes.
Higher Preoperative NarxCare Scores Linked to Adverse Outcomes After Primary Total Hip Arthroplasty
The study aimed to identify a preoperative NCS threshold for poor outcomes, a link between preoperative NCS and LOS, discharge disposition, 90-day readmission, and reoperation rates following initial THA. Higher NCS was linked to longer LOS, 90-day readmission, & reduced probabilities of home release. NCS of 300 may be utilised to identify people at risk for THA complications.
Fragility Fracture of the Upper Extremity and Foot or Ankle Should Be Considered Sentinel Events
This study aimed to examine patient demographics, bone disease severity, prior fracture frequency, and osteoporosis treatment frequency by anatomic location of fragility fracture. Fragility fractures of the foot/ankle occur in people with less severe metabolic bone disease and should be referred for bone health evaluation.
Periprosthetic Femur Fracture Risk: Influenced by Stem Choice, Not Surgical Approach
This study's goal is to assess the 90-day relative risk of PFF based on method and stem type. PFF is a prevalent cause of failure after total hip arthroplasty (THA). Based on their single-center experience, collared stems and fit-and-fill stems lower the risk of periprosthetic fracture within 90 days. A female's age and BMI below 25 increase PFF risk. No anaesthesia reduced fracture rates.
Association between Femoral Stem Type and the Risk of Aseptic Revision following Hemiarthroplasty
In the treatment of displaced femoral neck fractures in the elderly, uncemented hemiarthroplasty had higher risk of aseptic revision than cemented hemiarthroplasty. Aseptic revision risk was assessed with three uncemented hemiarthroplasty stem designs. Uncemented stem designs have higher incidence of aseptic revision than cemented fixation.
Knee Arthroscopy Prior to Revision TKA linked with Increased Revision for Stiffness
The study aimed to evaluate the impact of knee arthroscopy on outcomes of subsequent TKA revision surgery. This cohort matched analysis found patients who had prior knee arthroscopy were likely to need revision TKA than individuals who received revision TKA without prior knee arthroscopy. Patients who had prior knee arthroscopy within 6 months had a higher risk of needing revision.
