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Cardiac Surgery
Study: Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease
Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass
Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Off-Pump CABG Raises Long-Term Mortality Risk – Cardiobrief (free) AND Newer method of open-heart surgery carries more risks, study finds – STAT (free)
The 10-Year Prognostic Value of Zero and Minimal CAC
The 10-Year Prognostic Value of Zero and Minimal CAC – Journal of The American College of Cardiology (no abstract – $ for full text)
Commentary: Calcium in Arteries Influences Heart Attack Risk – UT Southwestern Medical Center, via NewsWise (free) AND Study: Calcium in arteries influences heart attack risk – UPI (free)
“Half of the participants had no calcium deposits in their arteries or a zero coronary artery calcium, or CAC, score, and had less than a 3 percent chance of a cardiovascular event over a 10-year period despite having other risk factors for heart disease and stroke such as type 2 diabetes, high blood pressure and high bad cholesterol levels” (from UPI)
Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease
Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease – Journal of The American College of Cardiology (link to abstract and infographic – $ for full-text)
Commentary: Atrial Fibrillation in Congenital Heart Disease – American College of Cardiology, Latest in Cardiology (free)
The Future of Cardiovascular Magnetic Resonance Imaging
Review: The Future of Cardiovascular Magnetic Resonance Imaging – European Heart Journal (free)
Source: Medscape
Eliminating CK–MB Testing in Suspected Acute Coronary Syndrome
Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome: A Value-Based Quality Improvement – JAMA Internal Medicine (free) (RT @EricTopol see Tweet)
Author interview: Eliminating Creatine Kinase–Myocardial Band Testing in Suspected ACS (free)
Commentaries: Eliminating CK-MB Testing in Suspected ACS – American College of Cardiology, Latest in Cardiology (free) AND Research review recommends eliminating widely ordered blood test for diagnosing heart attacks – Johns Hopkins Medicine, via Science Daily (free)
“Review is first publication from national consortium of academic medical centers working to eliminate unnecessary medical tests, treatments and procedures” (from Science Daily)
Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome
Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials – The Lancet (link to abstract – $ for full-text)
Commentary: Optimal Timing of an Invasive Strategy in NSTE-ACS Patients – American College of Cardiology, Latest in Cardiology (free)
An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in most patients with NSTE-ACS, but seems to reduce mortality in high-risk patients.
Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery
Summary with 10 key points to remember: Perioperative Myocardial Injury and Infarction After CABG – American College of Cardiology, Latest in Cardiology (free)
Resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients
This meta-analysis, mainly from observational studies and including 1276 patients, suggests a positive effect of REBOA on mortality among non-compressible torso hemorrhage patients.
Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement
Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement – Circulation (free)
Commentary: Fewer infections in mechanical heart valves – Karolinska Institutet (free)
In this large cohort with follow-up time of up to 18 years, the risk of endocarditis was about 50 per cent higher with a biological prosthesis than with a mechanical prosthesis.
Comparison of Stenting Versus Bypass Surgery According to the Completeness of Revascularization in Severe Coronary Artery Disease
Commentaries: Surgery vs. Stents With Complete Revascularization – American College of Cardiology, Latest in Cardiology (free) AND PCI Matches Surgery for Multivessel Disease: But technical success with percutaneous procedure is critical – MedPage Today (free registration required)
Related study: Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease – Journal of The American College of Cardiology (free)
Results are comparable as long as complete revascularization has been achieved, additional randomized trials testing this hypothesis needed.
Acute Aortic Syndromes: Diagnosis and Management
Summary with 10 key points to remember: Acute Aortic Syndromes: Diagnosis and Management – American College of Cardiology, Latest in Cardiology (free)
Original Article: Acute aortic syndromes: diagnosis and management, an update – European Heart Journal (link to abstract – $ for full-text)
The Evolving Story of Overlapping Surgery
Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)
Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)
This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.
Pericarditis as a Marker of Occult Cancer and a Prognostic Factor for Cancer Mortality
Pericarditis as a Marker of Occult Cancer and a Prognostic Factor for Cancer Mortality – Circulation (link to abstract – $ for full-text)
Commentary: Pericarditis as a Marker of Occult Cancer – American College of Cardiology, Latest in Cardiology (free)
Association of delay of urgent or emergency surgery with mortality and use of health care resources
Commentary: Patients whose emergency surgery is delayed are at higher risk of death – Canadian Medical Association Journal, via EurekAlert (free)
Source: STAT News Newsletter
“Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs”.
Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain
Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain – Circulation (link to abstract – $ for full-text)
Commentary: CT angiography appears better at predicting future risk for patients with chest pain – Massachusetts General Hospital, via ScienceDaily (free)
Source: EvidenceAlerts (free resource to find articles of interest)
“The most important result indicated that the ability of coronary CTA to identify nonobstructive coronary artery disease – a less-than-70-percent narrowing of a coronary artery – identifies an at-risk group of patients not found by functional testing” (from ScienceDaily)
CABG vs DES for Non–ST-Elevation Acute Coronary Syndrome and left main or multivessel CAD
Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non–ST-Elevation Acute Coronary Syndrome – The American Journal of Cardiology (link to abstract – $ for full-text)
Source: EvidenceAlerts
In patients with Non–ST-Elevation Acute Coronary Syndrome and left main or multivessel CAD, CABG significantly reduced the risk of death from any causes, myocardial infarction, or stroke compared with PCI with drug-eluting stents
A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery
A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)
Source: EvidenceAlerts (free resource to find articles of interest)
“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”
Trends and Outcomes of Off-Label Use of Transcatheter Aortic Valve Replacement
The JAMA Network – For the Media: Study Examines Use, Outcomes of Valve Replacement Procedure Performed for Off-Label Indications
Commentary: Outcomes of Off-Label Use of TAVR – American College of Cardiology, Latest in Cardiology (free)
“A randomized controlled trial directly comparing TAVR with surgery among specific subsets of off-label populations is needed to provide convincing evidence, and significant ‘off-label’ use captured in registries such as this should motivate such prospective randomized studies” (from Latest in Cardiology).
Guideline summary: Consensus on Surgical Treatment of Infective Endocarditis
Original article: 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary (link to abstract – $ for full-text)
Antiplatelet Therapy in Patients With Coronary Stents Undergoing Elective Noncardiac Surgery
Inspired by War Zones, Balloon Device May Save Civilians From Fatal Blood Loss
Inspired by War Zones, Balloon Device May Save Civilians From Fatal Blood Loss – The New York Times (10 articles per month are free)
Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery
Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery: A Danish Nationwide Population-Based Cohort Study – Circulation: Cardiovascular Quality and Outcomes (link to abstract – $ for full-text)
Commentary: Many good years after heart bypass surgery, but something happens after ten years – Aarhus University, via Science Daily (free)
“For patients who make it through the first month after the operation is close to that of the population in general. But 8-10 years after a heart bypass operation, mortality increases by 60-80 per cent” (from Science Daily)
Recommendations for the Use of Mechanical Circulatory Support
See also: News release (free) AND Top Ten Things to Know (free PDF)
Related: Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association (free PDF) AND CPR in Patients With Mechanical Circulatory Support – American College of Cardiology, Latest in Cardiology(free)
Management of pericardial disease
A New Renaissance in Pericardial Diseases – Progress in Cardiovascular Diseases (special issue with series of review articles on the management of pericardial disease).
Source: Hospital Medicine Virtual Journal Club
1 – Introduction: A New Renaissance in Pericardial Diseases (free)
2 – Structure and Anatomy of the Human Pericardium (free)
3 – Pathophysiology of the Pericardium (free)
4 – Acute Pericarditis (free)
5 – Recurrent Pericarditis (free)
6 – Constrictive Pericarditis: A Practical Clinical Approach (free)
7 – Pericardial Effusions: Causes, Diagnosis, and Management (free)
8 – Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging (free)
9 – Congenital Absence of the Pericardium (free)
10 – Surgical Management of Pericardial Diseases (free)
Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease
Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease – Cochrane Library (link to abstract – $ for full-text) (RT @Gas_Craic see Tweet)
“Compared with culprit-only intervention, the complete revascularisation strategy may be superior due to lower proportions of long-term cardiovascular mortality, long-term revascularisation, and long-term non-fatal myocardial infarction, but these findings are based on evidence of very low quality”
Reducing Recurrent Stroke With PFO Closure
Finally, Success Reducing Recurrent Stroke With PFO Closure – Medscape (free registration required)
Two randomized trials presented at the 3rd European Stroke Organization Conference (ESOC) 2017 showed that in carefully selected stroke patients in whom Patent Foramen Oval (PFO) was suspected to be a cause of their strokes, a reduction in recurrent stroke was observed with PFO closure.
Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing
Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing – Journal of The American College of Cardiology (link to abstract – $ for full-text) (source: EvidenceAlerts)
Related recent meta-analysis: Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Trials – Circulation: Cardiovascular Interventions (free) AND Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis – BMC Medicine (free)
PCI with drug-eluding stents seems to be a safe alternative to CABG in Unprotected Left Main Coronary Artery Stenosis, but it is associated with higher rates of repeat revascularization.
Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images
Source: Management of Pulmonary Nodules Found Incidentally on Computed Tomography Scans – Journal Watch (free)
Incidental pulmonary nodules discovered outside the context of screening or cancer follow-up are increasingly common in clinical practice. The purpose of these updated recommendations is to reduce the number of unnecessary follow-up examinations while providing practical guidance on follow-up intervals for selected larger nodules.
Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017
Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 – JAMA Surgery (free) (RT @jankluytmans and @CIDRAP_ASP see Tweet)
Invited commentary: Surgical Site Infection Prevention – What We Know and What We Do Not Know – JAMA Surgery (free)
Commentary: ‘Long-Awaited’ CDC Guidelines on SSI Prevention Released – Medscape (free registration required)
Related: Global guidelines on the prevention of surgical site infection 2016 – World Health Organization (free)
Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients
Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients – New England Journal of Medicine (link to abstract – $ required for full text)
Quick Take Video Summary: SURTAVI Study: TAVR versus Open Surgery (free)
See this and other highlights from the American College of Cardiology’s 66th Annual Scientific Session (some articles are no longer free)
This innovative technology seems to be useful for patients with aortic stenosis at high risk for surgery. In this new study, it was noninferior to surgery at 2 years of follow-up in old patients (averaged nearly 80 years) at intermediate risk. Longer follow up data will be important to see if it is a suitable alternative for younger patients.
American College of Radiology (ACR) Appropriateness Criteria Adds Topics
ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)
Browse Appropriateness Criteria Topics (free)
Source: Newswise
This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.
