Cardiology News / Recent Literature Review / First Quarter 2017
AbstractHRS Scientific sessions: Chicago, 10-13/5/2017EHRA Europace-Cardiostim: Vienna, 18-21/6/2017ESC Congress: Barcelona, 26-30/8/2017TCT Congress: Denver, Colorado, 29/10-2/11/2017AHA Meeting: Anaheim, Ca, 11-15/11/2017Anterior T-Wave Inversion (ATWI), Present in 2.3% of Young Whites, More Common in Women and in Athletes, 77% Confined to Leads V1 - V2, Could be a Normal Variant in Asymptomatic Individuals Without a Family History of Cardiomyopathy or Premature SCD / In Contrast, ATWI Extending Beyond V2, Present in only 1% of Females and 0.2% in Men, May Justify Further Evaluation, Particularly when Preceded by J-Point or ST-Segment Depression Among 14,646 individuals 16 to 35 years of age, including 4,720 females (32%) and 2,958 athletes (20%), ATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p< 0.0001) and more common among athletes than in nonathletes (3.5% vs 2%, respectively; p<0.0001). T-wave inversion was predominantly confined to leads V1 to V2 (77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V2. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. Over 23.1±12.2 months none of the individuals with ATWI experienced an adverse event (Malhotra A et al, J Am Coll Cardiol 2017;69:1-9).Alcohol Abuse Increases the Risk of AF, MI, and Heart Failure to an Extent Similar to that of Other Strong Risk Factors, and Affects Healthier Individuals Disproportionately / Protective Effects of Alcohol Against MI are Outweighed at Heavy Levels of Consumption by its Adverse Effects Among 14,727,591 patients, 268,084 (1.8%) had alcohol abuse, which was associated with an increased risk of incident atrial fibrillation (AF) (hazard ratio -HR: 2.14; p<0.0001), myocardial infarction (MI) (HR: 1.45; p< 0.0001), and heart failure (HF) (HR: 2.34; p<0.0001). Individuals without conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk of each outcome. The population-attributable risk of alcohol abuse on each outcome was of similar magnitude to other well-recognized modifiable risk factors (Whitman IR et al, J Am Coll Cardiol 2017;69:13-24).LEADERS FREE Trial: in Patients at High Risk of Bleeding Undergoing PCI Followed by 1 Month of Dual Antiplatelet Therapy (DAPT), Polymer-Free Drug-Coated Stents (DCS) are both Safer and More Effective Than Bare Metal Stents (BMS) at 2 Years Among 2,466 high bleeding risk patients randomized to a drug-coated stent (DCS) or a BMS followed by 1-month DAPT, at 2 years, the primary safety endpoint (cardiac death, MI, or stent thrombosis) had occurred in 147 DCS (12.6%) and 180 BMS patients (15.3%) (hazard ratio-HR: 0.80; p = 0.039). Clinically driven target lesion revascularization occurred in 77 DCS (6.8%) and 136 BMS patients (12%) (HR: 0.54; p< 0.0001). Major bleeding occurred in 8.9% of DCS and 9.2% of BMS patients (p= 0.95), and a coronary thrombotic event (MI and/or stent thrombosis) occurred in 8.2% of DCS and 10.6% of BMS patients (p= 0.045). One-year mortality was 27.1% for a major bleed and 26.3% for a thrombotic event. At 2 years, multivariate correlates of major bleeding were age >75 years, anemia, increased creatinine, and long-term anticoagulation. Correlates of the primary safety endpoint were age, anemia, heart failure, multivessel disease, number of stents, and use of a BMS (Garot P et al, J Am Coll Cardiol 2017;69:162-171)... (excerpt)Rhythmos 2017;12(2):33-37.
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