Intravascular Ultrasound–Guided Percutaneous Coronary Intervention: An Updated Review

Common practice dictates the performance of percutaneous coronary intervention under conventional angiographic guidance. With studies suggesting the high incidence of intraobserver variability, especially in angiographic borderline lesions, new modalities such as intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention have surfaced. Multiple studies have shown improved outcomes with IVUS guidance, mainly driven by a decrease in ischemia-driven target lesion revascularization. In the past two decades, a multitude of studies have investigated the uses and clinical outcomes associated with this technology. In this review, we highlight the utility, advantages, economic implications, and clinical outcomes of IVUS guidance over standard angiographic guidance, with emphasis on data as they pertain to IVUS-guided stent implantation

Evaluation of aspirin and statin therapy use and adherence in patients with premature atherosclerotic cardiovascular disease

Importance: Studies on the use of and adherence to secondary prevention therapies in patients with premature and extremely premature atherosclerotic cardiovascular disease (ASCVD) are lacking.Objective: To evaluate and compare aspirin use, any statin use, high-intensity statin use, and statin adherence among patients with premature or extremely premature ASCVD compared with patients with nonpremature ASCVD.Design, setting, and participants: This multicenter cross-sectional study used the clinical and administrative data sets of the US Department of Veterans Affairs (VA) to identify adult patients with at least 1 primary care visit in the VA health care system between October 1, 2014, and September 30, 2015. The study cohort comprised patients with ASCVD (ischemic heart disease, peripheral arterial disease, or ischemic cerebrovascular disease) who were enrolled in the Veterans With Premature Atherosclerosis (VITAL) registry. Patients with missing data for date of birth or sex and those with limited life expectancy were excluded. Data were analyzed from November 1, 2019, to January 1, 2020.Exposures: Premature (the first ASCVD event occurred at age women) vs nonpremature (the first ASCVD event occurred at age ≥55 years for men or age ≥65 years for women) ASCVD and extremely premature (the first ASCVD event occurred at age \u3c40 \u3eyears) vs nonpremature ASCVD.Main outcomes and measures: The primary outcomes were aspirin use, any statin use, high-intensity statin use, and statin adherence (measured by proportion of days covered [PDC] ≥0.8).Results: Of the 1 248 158 patients identified, 135 703 (10.9%) had premature ASCVD (mean [SD] age, 49.6 [5.8] years; 116 739 men [86.0%]), 1 112 455 (89.1%) had nonpremature ASCVD (mean [SD] age, 69.6 [8.9] years; 1 104 318 men [99.3%]), and 7716 (0.6%) had extremely premature ASCVD (mean [SD] age, 34.2 [4.3] years; 6576 men [85.2%]). Patients with premature ASCVD vs those with nonpremature ASCVD had lower rates of aspirin use (96 468 [71.1%] vs 860 726 [77.4%]; P \u3c .001) and any statin use (98 908 [72.9%] vs 894 931 [80.5%]; P \u3c .001); had a statin PDC of 0.8 or higher (57 306 [57.9%] vs 644 357 [72.0%]; P \u3c .001); and a higher rate of high-intensity statin use (49 354 [36.4%] vs 332 820 [29.9%]; P \u3c .001). Similarly, patients with extremely premature ASCVD were less likely to use aspirin (odds ratio [OR], 0.27; 95% CI, 0.26-0.29), any statin (OR, 0.25; 95% CI, 0.24-0.27), or high-intensity statin (OR, 0.78; 95% CI, 0.74-0.82) and to be statin adherent (OR, 0.44; 95% CI, 0.41-0.47).Conclusions and relevance: In this study, patients with premature or extremely premature ASCVD appeared to be less likely to use aspirin or statins and to adhere to statin therapy. This finding warrants further investigation into premature ASCVD and initiatives, including clinician and patient education, to better understand and mitigate the disparities in medication use and adherence

Methodological rigor and temporal trends of cardiovascular medicine meta-analyses in highest-impact journals

Background Well-conducted meta-analyses are considered to be at the top of the evidence-based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine-related meta-analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine-related systematic reviews and meta-analyses published i

Emerging lipid-lowering therapies in secondary prevention

Purpose of Review: The primary purpose of this article was to review the next-generation lipid-lowering therapies that are under current development and clinical testing. We reviewed the mechanism of action of these drugs and how they act on different pathways of lipid metabolism. Additionally, we aimed to present data from clinical trials evaluating clinical outcomes, efficacy, and safety of these novel agents. Lastly, we sought to provide recommendations for clinical practice and to comment on the cost-benefit analyses of such drugs.Recent Findings: We evaluated the following lipid-lowering agents as they pertain to secondary prevention of atherosclerotic cardiovascular disease (ASCVD): ezetimibe, proprotein convertase subtilisin/kexin (PCSK) type 9 inhibitors, cholesteryl ester transfer protein inhibitors, and eicosapentaenoic acid ethyl ester. The two novel therapies currently approved by the US Food and Drug Administration and endorsed by the latest ACC/AHA cholesterol guidelines include ezetimibe and PCSK9 inhibitors. Although other drug classes have shown promising preliminary results, clinical trials evaluating cardiovascular outcomes are ongoing.Summary: Patients with known ASCVD are at risk for recurrent ischemic events. Lipid-lowering therapies are an integral part of secondary prevention measures in such patients. There has been an upsurge in development of newer generation lipid-lowering therapies which have shown excellent results in preclinical studies. When added to statin therapy in high-risk patients or patients with suboptimal lipid profile despite statin therapy, these agents may significantly lower recurrent adverse cardiovascular events. Thorough cost-effectiveness simulations need to be performed prior to introduction of these agents in routine clinical practice

From CoreValve to Evolut PRO: Reviewing the Journey of Self-Expanding Transcatheter Aortic Valves

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s40119-017-0100-z">https://link.springer.com/article/10.1007/s40119-017-0100-z</a></p><p></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p

Improving adherence to cardiovascular guidelines: Realistic transition from paper to patient

Introduction: The emphasis on clinical trials to inform evidence-based medicine remains paramount within the cardiovascular community. Although such high-quality evidence is often translated into national and international guidelines, there exists a large gap between guideline development and guideline implementation into daily clinical practice.Areas covered: This article outlines barriers that impede guideline adherence and possible strategies to overcome such barriers. Barriers intrinsic and extrinsic to clinicians are discussed. The structured process of guideline implementation including guideline adoption, diffusion, and dissemination is discussed. Lastly, the authors review in detail the current and potential future elements of guideline diffusion and dissemination.Expert opinion: Improving guideline adherence remains challenging as it requires understanding of and navigation through various barriers. However, further research specific to cardiovascular medicine guidelines is necessary to better understand the objective effectiveness of various strategies employed by guideline writers and medical societies to improve adherence. The cost-effectiveness of nationwide dissemination strategies in improving guideline adherence and patient outcomes is also necessary but is largely unknown

Optimum Antithrombotic Therapy in Patients Requiring Long-Term Anticoagulation and Undergoing Percutaneous Coronary Intervention

Management of patients on long-term anticoagulation requiring percutaneous coronary intervention is challenging. Triple therapy with oral anticoagulant and dual antiplatelet therapy is the standard of care. However, there is no strong evidence to support this strategy. There is emerging data regarding the safety and efficacy of dual therapy with oral anticoagulant and single antiplatelet therapy in these patients. In this comprehensive review we highlight available evidence regarding various antithrombotic regimens’ efficacy and safety in patient with coronary artery disease undergoing percutaneous coronary intervention with long-term anticoagulation therapy requirements

Premature atherosclerotic cardiovascular disease: What have we learned recently?

Purpose of review: In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD.Recent findings: In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed