Commentaries: Newborn Screening Policies For CHD Associated With Lower Infant Deaths – American College of Cardiology, Latest in Cardiology (free) AND Infant CCHD deaths cut by 33% after mandatory pulse oximetry testing – Cardiovascular Business (free) AND Screening for Critical Congenital Heart Disease at Birth Saves Lives – CDC (free)
Related guideline: Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease (free)
Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI) – Journal of Cardiovascular Magnetic Resonance (free)
“The European Atlas of Cardiology brings together data from 56 countries to demonstrate the prevalence and cost of cardiovascular disease, and the need to utilise resources more effectively” (RT @OUPMedicine see Tweet)
Commentaries: Neither Sodium Bicarbonate nor Oral Acetylcysteine Prevents Contrast-Induced Kidney Injury – Physician’s First Watch (free) AND PRESERVE: No Benefit from Sodium Bicarbonate, Acetylcysteine After Angiography – Medscape (free registration required)
Commentaries: TRICS III: Restrictive Red-Cell Transfusion Noninferior to Liberal Use in Cardiac Surgery – TCTMD (free) AHA: Restrictive Blood Transfusion OK for Select Patients – MedPage Today (free registration required)
Related article: Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial – JAMA (free)
Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Mechanical heart valve often the safest choice – Stanford Medicine (free) AND Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement? – NEJM 360 Resident (free) AND Mechanical or Tissue Valve for AVR and MVR – American College of Cardiology, Latest in Cardiology (free) AND Mechanical Valves Show Mortality Benefit Over Biologic Valves – Medscape (free registration required) AND Heart valve replacement success may depend on age, valve type – Reuters (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentaries: Small Trial Raises Big Concerns That PCI In Stable Angina Is Just A Placebo – Cardiobrief (free) AND Diving Deep Into The ORBITA Trial – Cardiobrief (free) AND ‘Unbelievable’: Heart Stents Fail to Ease Chest Pain – The New York Times (10 articles per month are free) AND ORBITA: PCI Offers No Symptom Improvement Over Sham Procedure – TCTMD (free)
Commentaries: CULPRIT-SHOCK Disputes Benefit of Immediate Multivessel PCI in Patients With Cardiogenic Shock – TCTMD (free) AND CULPRIT-SHOCK: Culprit Lesion Only PCI Vs. Immediate Multivessel PCI in Cardiogenic Shock – American College of Cardiology, Latest in Cardiology (free)
Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study – The Lancet (link to abstract – $ for full-text)
Commentaries: Why Heart Surgery May be Better in the Afternoon – Scientific American (free) AND Afternoon heart surgery has lower risk of complications, study suggests – The Guardian (free) AND Aortic Valve Replacement: Afternoon Surgery Linked to Fewer Adverse Events – Physician’s First Watch (free)
Commentaries: High Blood Pressure Is a Risk Factor For Mitral Regurgitation – Medical Research (free) AND High Blood Pressure May Raise Mitral Regurgitation Risk – TCTMD (free) AND Inevitable or preventable? High blood pressure linked to mitral regurgitation – Cardiovascular Business (free)
Commentaries: Expert Consensus Decision Pathway for Management of Mitral Regurgitation – American College of Cardiology, Latest in Cardiology (free) AND ACC Recommends ‘Structured Approach’ to Mitral Regurgitation – MedPage Today (free registration required)
Commentaries: 2017 AUC for Management of Severe Aortic Stenosis – American College of Cardiology, Latest in Cardiology (free) AND First Appropriate Use Criteria Issued for Severe Aortic Stenosis – Medpage Today (free registration required)
Original article: Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis – Heart (link to abstract – $ for full-text)
Commentaries: Study: Triple-Vessel CABG Strategy Matters in the Long Run – MedPage Today (free registration required)
In patients with multivessel disease who are undergoing coronary artery bypass grafting, multiple arterial grafting (MAG) is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure when compared with left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG).
News release: Looking beyond the heart in adults with congenital heart disease (free)
Top Ten Things to Know: Diagnosis and Management of Noncardiac Complications in Adults with Congenital Heart Disease (free PDF)
Predicting 30-Day Mortality for Patients With Acute Heart Failure in the Emergency Department: A Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Tool may help accurately predict 30-day mortality for emergency department patients with acute heart failure – 2 Minute Medicine (free) AND Simple tool accurately predicts 30-day mortality for patients with acute heart failure in the ER – MedicalXpress (free)
See Calculator: MEESSI-AHF RISK MODEL
Invited commentary: Coronary Computed Tomographic Angiography—The First Test for Evaluating Patients With Chest Pain? (free)
Coronary Computed Tomografic Angiography (CCTA) was associated with a very small reduction in the incidence of myocardial infarction (0.7% vs 1.1% = 0.4% absolute risk reduction), but without differences in death or cardiac hospitalization. Patients undergoing CCTA were significantly more likely to undergo invasive coronary angiography (11.7% vs 9.1%), revascularization (7.2% vs 4.5%) and were also more likely to receive a diagnosis of new CAD and to have initiated aspirin or statin therapy.
D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial – Journal of Thrombosis and Haemostasis (link to abstract – $ for full-text)
Source: ACP Journal Wise ($)
News release: Treatment for tuberculosis infection of the membrane around the heart (free)
“For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant”.
Association of Guideline Adherence for Serial Evaluations With Survival and Adverse Clinical Events in Patients With Asymptomatic Severe Aortic Stenosis – JAMA Cardiology (link to abstract – $ for full-text)
Commentaries: Serial Echos Valuable in Patients with Asymptomatic Severe Aortic Stenosis – Physician’s First Watch (free) AND Close Watch on Aortic Stenosis May Improve Outcomes – MedPage Today (free registration required)
Survival and Cardiovascular Outcomes of Patients With Secondary Mitral Regurgitation: A Systematic Review and Meta-analysis – JAMA Cardiology (link to abstract – $ for full-text)
Commentary: Even Mild Secondary Mitral Regurgitation Tied to Reduced Survival – MedPage Today (link to abstract – $ for full-text)
Original articles from the New England Journal of Medicine: Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke (link to abstract – $ for full-text) AND Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke (link to abstract – $ for full-text) AND Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke (link to abstract – $ for full-text)
Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Palliative Care Intervention Improves Quality of Life in Advanced Heart Failure Patients – American College of Cardiology, Latest in Cardiology (free) AND Palliative Care & CHF: PAL-HF trial – Pallimed (free)
Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence – Journal of The American College or Cardiology (link to abstract – $ for full-text)
Commentaries: Long-Term Outcomes of Spontaneous Coronary Artery Dissection – American College of Cardiology, Latest in Cardiology (free) AND Spontaneous Coronary Dissection Often Followed By MACE Long Term – MedPage Today (free registration required)
Beta-blockers were associated with less recurrence in this observational study.
Improving the Appropriate Use of Transthoracic Echocardiography: The Echo WISELY Trial – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Improving Echo Appropriateness: Audit and Feedback Intervention Works – TCTMD (free) AND Improving Appropriate Use of Transthoracic Echocardiography – American College of Cardiology, Latest in Cardiology (free)
Commentary with highlights from the document: Appropriate Use Criteria Published for Valvular Heart Disease Imaging Tests – American College of Cardiology, Latest in Cardiology (free)
Impact of Obesity on Intensive Care Unit Resource Utilization After Cardiac Operations – The Annals of Thoracic Surgery (link to abstract – $ for full-text)
Commentaries: Obese cardiac patients a drain on ICU resources – Cardiovascular Business (free) AND Obese Cardiac Surgery Patients a Burden on ICU Resources – TCTMD (free) AND Post–Cardiac Surgery ICU Usage Rises With Increasing Obesity – Medscape (free registration required)
Original article: Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease – Cochrane Library (link to abstract – $ for full-text)
Underweight associated with highest mortality and costs after cardiac catheterization (free) (the results have not been published yet)
Commentaries: Underweight and Overlooked: Low BMI Patients May Be Highest-Risk Post-PCI – TCTMD (free) AND Underweight Patients Fare Worse After Heart Catheterization – Medscape (free registration required) AND ESC 2017: Underweight Is Associated With Highest Mortality and Costs After Cardiac Catheterization – PracticeUpdate (free registration required)
Commentaries: SPECT, PET, and CTA—Acronyms or Better Imaging? – JAMA Cardiology (free) PET More Accurate for Diagnosing CAD Than SPECT and CT Angiography: PACIFIC Study – TCTMD (free) PET Dominates in Non-invasive CAD Detection Accuracy – MedPage Today (free)
Closure of left atrial appendage during heart surgery protects the brain (LAACS) – ESC Press Releases (free) (the results have not been published yet)
See also: #ESCCongress Slides (free PPT file)
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) (free) (RT @rafavidalperez see Tweet)
Commentary: ESC Updates Guidelines for Treating STEMI Patients – TCTMD (free)
See also: #ESCCongress Slides (free PPT file)
CI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Patients With Type 1 Diabetes and Multivessel Disease Have Greater Benefit From CABG Than PCI – American College of Cardiology, Latest in Cardiology (free) AND Revascularization in Patients With Type 1 Diabetes – American College of Cardiology, Latest in Cardiology (free)
“The observational findings support existing recommendations favoring surgical revascularization in patients with diabetes” (from TCTMD).
Editorial: Rheumatic Heart Disease — An Iceberg in Tropical Waters (free) (RT @NEJM see Tweet with interesting table)
Quick Take Video Summary: What is the Global Burden of Rheumatic Heart Disease? (free)
Commentaries: Smokers hospitalized for heart attacks often don’t get cessation drugs – Reuters (free) AND Smokers Hospitalized for CHD Rarely Receive Cessation Pharmacotherapy During Hospitalization – American College of Cardiology, Latest in Cardiology (free)
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 – Journal of The American College of Cardiology (no abstract – $ for full text)
“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 – Journal of The American College of Cardiology (link to abstract and infographic – $ for full-text)
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)
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)
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.
ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery (free)
Summary with 10 key points to remember: Perioperative Myocardial Injury and Infarction After CABG – American College of Cardiology, Latest in Cardiology (free)
A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients – World Journal of Emergency Surgery (free)
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.
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: Patient-Level Pooled Analysis of the SYNTAX, PRECOMBAT, and BEST Trials – Journal of The American College of Cardiology (free)
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)
Results are comparable as long as complete revascularization has been achieved, additional randomized trials testing this hypothesis needed.
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)
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 – Circulation (link to abstract – $ for full-text)
Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study – Canadian Medical Association Journal (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 – Circulation (link to abstract – $ for full-text)
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)
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)
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
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”
The JAMA Network – For the Media: Study Examines Use, Outcomes of Valve Replacement Procedure Performed for Off-Label Indications
“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).
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)
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: A Danish Nationwide Population-Based Cohort Study – Circulation: Cardiovascular Quality and Outcomes (link to abstract – $ for full-text)
“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)
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)
A New Renaissance in Pericardial Diseases – Progress in Cardiovascular Diseases (special issue with series of review articles on the management of pericardial disease).
4 – Acute Pericarditis (free)
5 – Recurrent Pericarditis (free)
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”
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.
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.
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.
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)
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.
Browse Appropriateness Criteria Topics (free)
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.