Cardiology update 2017: The first quarter

In the first quarter of 2017, proprotein convertase subtilisin/kexin type 9's role got defined further with a number of trials such as FOURIER, ORION-1, and SPIRE 1 and 2. TAVI proves safe in intermediate-risk patients in the Surgical Replacement and Transcatheter Aortic Valve Implantation study. Newer anticoagulants extended their role to valvular heart disease. Bioabsorbable stent showed problems (ABSORB 2 and 3). New guidelines have been released for syncope and transcatheter aortic valve replacement implantation. Clinical outcome studies involving instantaneous wave-free ratio (IFR) showed IFR to be noninferior to fractional flow reserve. Optimal medical therapy proves noninferior to percutaneous coronary intervention in single vessel chronic total occlusion

Cardiac stem cell therapy: Current status

Cardiac injury due to any cause leads to cardiac cell damage and thereby to ventricular dysfunction. Unlike current medical therapy, cardiac regeneration by stem cell therapy is a promising approach which has a potential to reverse left ventricular dysfunction. It is conceived to complement and potentially transform available therapeutic armamentarium. Early experience in clinical studies support the safety and feasibility of cell therapy and as adjuvants to established practice. This review discusses type of stem cells used, its therapeutic indications, and its current status

Cardiology update 2017: The third quarter

In the third quarter of 2017, culprit only percutaneous coronary intervention (PCI) fares better in acute myocardial infarction with shock, guided de-escalation antiplatelet therapy seems noninferior, drug-eluting stent (DES) better in elderly patients undergoing PCI, DES with ultrathin struts proves superior, atrial fibrillation ablation improves left ventricular function in idiopathic cardiomyopathy, and edoxaban beneficial in preventing cancer-associated venous thromboembolism

Cardiology update 2018: The first quarter

Trials addressing the PCSK9 inhibitors, wearable cardioverter defibrillator, genotype-guided antiplatelet therapy, his bundle pacing, and therapies for HFpEF were discussed in American College of Cardiology 2018. TASMINH4 evaluated the need for self-monitoring and telemonitoring of blood pressure in the management of patients with poorly controlled blood pressure. In heart failure, issues regarding temporal trends and patterns of incidence, NT-proBNP, HeartMate pump, immunosuppression (sirolimus versus calcineurin) in heart transplant recipients, and aspirin use were evaluated in various trials. Drug-eluting balloon, MiStent, Resolute Onyx 2.0 drug-eluting stent, Omega-3 fatty acids, safety of drugs used in the treatment of gout (febuxostat versus allopurinol), and preventive strategies for those at risk for renal complications were tested in patients with coronary artery disease. Smokers were compared with nonsmokers presenting with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in terms of clinical, angiographic, and outcomes. Association of influenza infection with acute myocardial infarction was also tested. A good number of trials tested different antiplatelets in different manners

Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization

Background & Objectives: This longitudinal study was carried out to evaluate the prognostic significance of fragmented QRS (fQRS) in patients with acute ST elevation myocardial infarction (STEMI) undergoing revascularization. Methods: This study included 103 STEMI patients belonging to Killip class I and II who underwent primary revascularization. All patients underwent twelve lead ECG at admission before PCI. Serial ECG were done after PCI at 3 hours, 6 hours, 24 hours, 48 hours and at discharge for detection of fQRS and echocardiography on day 3 post revascularization. Patients developing fQRS within 48 hours and with persistence of fQRS till discharge were included in “persistent fQRS” group. They were followed up after 30 days for major adverse cardiac events (MACE) and assessment of LV function by echocardiography. Results: fQRS was present in 64 patients (61.5%) of study population with 37 patients (57.8%) having persistent fQRS. MACE rates were low (4.8%) and did not differ with respect to fQRS. fQRS significantly correlated with LV dysfunction at 30 days on univariate analysis (p-0.003) but not on multivariate analysis (p -0.10). fQRS was significantly related to impaired myocardial reperfusion as assessed by ΣSTR (percent of total ST segment resolution) (adjusted odds ratio, 95% CI [4.265 (1.034 – 17.58)], p = 0.04). Conclusion: In our study, fQRS did not predict MACE and LV dysfunction in acute STEMI patients belonging to Killip class I and II on short term follow-up of 30 days. But, fQRS independently predicted impaired microvascular myocardial reperfusion as assessed by ΣSTR