Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Oct 2019
Randomized Controlled Trial Multicenter StudyEfficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Multivessel PCI.
Data on optimal antiplatelet treatment regimens in patients who undergo multivessel percutaneous coronary intervention (PCI) are sparse. ⋯ Long-term ticagrelor monotherapy following 1-month DAPT can favorably balance ischemic and bleeding risks in patients with multivessel PCI. These findings should be interpreted as hypothesis-generating and need to be replicated in future dedicated randomized trials. (GLOBAL LEADERS: A Clinical Study Comparing Two Forms of Anti-platelet Therapy After Stent Implantation; NCT01813435).
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J. Am. Coll. Cardiol. · Oct 2019
Multicenter StudyDabigatran Reversal With Idarucizumab in Patients With Renal Impairment.
Dabigatran and idarucizumab, its reversal agent, are renally cleared. ⋯ Idarucizumab completely reverses dabigatran in >98% of patients regardless of renal function. Although re-elevation of dabigatran levels within 12 to 24 h is more common with renal impairment, the time to bleeding cessation and the extent of hemostasis during procedures are similar. (Reversal of Dabigatran Anticoagulant Effect With Idarucizumab; NCT02104947).
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J. Am. Coll. Cardiol. · Sep 2019
Meta Analysis Comparative StudyTranscatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients.
Transcatheter aortic valve replacement (TAVR) has emerged as a safe and effective therapeutic option for patients with severe aortic stenosis (AS) who are at prohibitive, high, or intermediate risk for surgical aortic valve replacement (SAVR). However, in low-risk patients, SAVR remains the standard therapy in current clinical practice. ⋯ In this meta-analysis of RCTs comparing TAVR versus SAVR in low-risk patients, TAVR was associated with significantly lower risk of all-cause death and cardiovascular death at 1 year. These findings suggest that TAVR may be the preferred option over SAVR in low-risk patients with severe AS who are candidates for bioprosthetic AVR.
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J. Am. Coll. Cardiol. · Sep 2019
Comparative StudyIn Silico Trial of Optimized Versus Actual Public Defibrillator Locations.
Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices. ⋯ Optimized AED placements increased OHCA coverage by approximately 50% to 100% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.
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Observational studies suggest associations between extremes of sleep duration and myocardial infarction (MI), but the causal contribution of sleep to MI and its potential to mitigate genetic predisposition to coronary disease is unclear. ⋯ Prospective observational and MR analyses support short sleep duration as a potentially causal risk factor for MI. Investigation of sleep extension to prevent MI may be warranted.