01 Oct 2019
Editor's picks: impactful articles in interventional cardiology
Stay up to date with new literature, studies and trials published in major journals
Struggling to keep up with the mass of scientific information in interventional cardiology? On this page you will find a selection of recent articles published in major journals in the field - use it to guide your reading!
Ticagrelor or prasugrel in patients with acute coronary syndromes
September 2019, The New England Journal of Medicine, Stefanie Schüpke et al.
Among patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor, and the incidence of major bleeding was not significantly different between the two groups.
read report from ESC congress 2019
Complete revascularization with multivessel PCI for myocardial infarction
September 2019, The New England Journal of Medicine, Shamir R. Mehta et al.
Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization.
read report from ESC congress 2019
Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study)
September 2019, European Heart Journal, Daniele Giacoppo et al.
In patients with coronary ISR, repeat stenting with DES is moderately more effective than angioplasty with PCB at reducing the need for TLR at 3 years. The incidence of a composite of all-cause death, myocardial infarction, or target lesion thrombosis was similar between groups.
Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease
June 2019, The New England Journal of Medicine, Eike Nagel et al.
The authors of this study performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI–based strategy or an FFR-based strategy.
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation
March 2019, The New England Journal of Medicine, Renato D. Lopes et al.
In patients with atrial fibrillation and a recent ACS or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both.
Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers
March 2019, The New England Journal of Medicine, Deepak L. Bhatt et al.
In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays.
Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients
March 2019, The New England Journal of Medicine, Jeffrey J. Popma et al.
In patients with severe aortic stenosis who were at low surgical risk, TAVR with a self-expanding supraannular bioprosthesis was noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months.
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients
March 2019, The New England Journal of Medicine, Michael J. Mack et al.
Among patients with severe aortic stenosis who were at low surgical risk, the rate of the composite of death, stroke, or rehospitalization at 1 year was significantly lower with TAVR than with surgery.
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years
January 2019, The New England Journal of Medicine, David P. Taggart et al.
Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis.
Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis
January 2019, The New England Journal of Medicine, Kasper Iversen et al.
In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment.
Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome
November 2018, The New England Journal of Medicine, Gregory G. Schwartz et al.
This study sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy.
Targeted therapy with a localised abluminal groove, low-dose sirolimus-eluting, biodegradable polymer coronary stent (TARGET All Comers): a multicentre, open-label, randomised non-inferiority trial
September 2018, The Lancet, Marco Valgimigli et al.
This study investigated clinical outcomes with a targeted, low-dose, biodegradable polymer, sirolimus-eluting stent compared with XIENCE durable polymer, everolimus-eluting stents in an all-comers population.
Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial
August 2018, The Lancet, Marco Valgimigli et al.
This study describes the final 1-year outcomes of the MATRIX programme, designed to assess the comparative safety and effectiveness of radial versus femoral access and of bivalirudin versus unfractionated heparin with optional glycoprotein IIb/IIIa inhibitors in patients with the whole spectrum of acute coronary syndrome undergoing invasive management.
Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial
August 2018, The Lancet, Pacal Vranckx et al.
This study sought to determine if ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens.
Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial
August 2018, The Lancet, Thomas Pilgrim et al.
This study sought to assess the final 5-year clinical outcomes of BIOSCIENCE with regards to the primary clinical outcome of target lesion failure.
Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial
August 2018, The Lancet, Raban V. Jeger et al.
This study sought to determine the safety and efficacy of drug-coated balloons in comparison with drug-eluting stents.
Coronary CT Angiography and 5-Year Risk of Myocardial Infarction
August 2018, The New England Journal of Medicine, The SCOT-HEART Investigators.
This study sought to evaluate the effect of CTA on 5-year clinical outcomes of patients with stable chest pain.
One-Year Outcomes after PCI Strategies in Cardiogenic Shock
August 2018, The New England Journal of Medicine, Holger Thiele et al.
This study sought to evaluate clinical outcomes at 1 year with percutaneous coronary intervention of the culprit lesion among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease.
Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation
August 2018, The New England Journal of Medicine, Jean-François Obadia et al.
This study sought to find out whether percutaneous mitral-valve repair improves clinical outcomes in patients who have chronic heart failure with reduced left ventricular ejection fraction.
Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease: Physiology-Stratified Analysis of ORBITA
May 2018, Circulation, Rasha Al-Lamee et al.
This study sought to find out datas on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease.
Five-Year Outcomes with PCI Guided by Fractional Flow Reserve
May 2018, The New England Journal of Medicine, Panagiotis Xaplanteris et al.
This study sought to determine if fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) is superior to medical therapy as initial treatment in patients with stable coronary artery disease.
A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions
May 2018, European Heart Journal, Gerald S. Werner et al.
The clinical value of percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) is not established by randomized trials. This study sought to compare the benefit of PCI vs. optimal medical therapy on the health status in patients with at least one CTO.
6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial
March 2018, The Lancet, Joo-Yong Hahn et al.
Available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. This study sought to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population.
Pharmacogenomic approach to selecting antiplatelet therapy in acute coronary syndromes: PHARMCLO trial
March 2018, JACC, Francesca Maria Notarangelo et al.
Clopidogrel is still frequently used in patients with acute coronary syndromes (ACS), but its efficacy is hampered by interpatient response variability, due to genetic polymorphisms associated with clopidogrel metabolism. This study sought to evaluate whether selecting antiplatelet therapy (clopidogrel, prasugrel or ticagrelor) on the basis of a patient’s genetic and clinical characteristics leads to better clinical outcomes in comparison with the standard of care, which bases the selection on clinical characteristics alone.
Effect of loading dose of Atorvastatin prior to planned percutaneous coronary intervention on major adverse cardiovascular events in acute coronary syndrome: the SECURE-PCI randomized clinical trial
March 2018, JAMA, Otavio Berwanger et al.
The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. This study sought to determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management.
Ticagrelor vs Clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial
March 2018, JAMA, Otavio Berwanger et al.
The bleeding safety of ticagrelor in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy remains uncertain. This study sought to evaluate the short-term safety of ticagrelor when compared with clopidogrel in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy.
A multidisciplinary approach on the perioperative antithrombotic management of patients with coronary stents undergoing surgery
March 2018, JACC: Cardiovascular Interventions, Roberta Rossini et al.
An update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents in various types of surgery, according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications.
Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data
February 2018, The Lancet, Stuart J. Head et al.
The optimal revascularisation strategy in patients with coronary artery disease has been debated for a few decades. The aim of this study was to perform a systematic review and meta-analysis of randomised trials comparing CABG and PCI using stents.
A Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients with Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization
February 2018, Circulation, Stefano Savonitto et al.
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS). Prasugrel 5 mg provides more predictable platelet inhibition, as compared to clopidogrel, in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding. This study sought to demonstrate the superiority of prasugrel 5 mg over clopidogrel 75 mg.
Safety and Effectiveness of Second-Generation Drug-Eluting Stents in Patients With Left Main Coronary Artery Disease
February 2018, Journal of the American College of Cardiology, Pil Hyung Lee et al.
Limited data are available on the relative performances between different types of drug-eluting stents (DES) for obstructive left main coronary artery disease (LMCAD). This study sought to compare effectiveness and safety profiles of various second-generation DES for LMCAD in real-world clinical practice.
New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial
February 2018, Journal of the American College of Cardiology, Ioanna Kosmidou et al.
This study sought to determine the incidence of new-onset atrial fibrillation following percutaneous coronary intervention and coronary artery bypass grafting for left main coronary artery disease and its effect on 3-year cardiovascular outcomes.
Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes
7 February 2018, JAMA Cardiology, Mauro Chiarito et al.
A systematic review and meta-analysis to evaluate the safety and efficacy of direct oral anticoagulants in addition to antiplatelet therapy after acute coronary syndromes, focusing on treatment effects stratified by baseline clinical presentation (non–ST-segment elevation ACS vs ST-segment elevation myocardial infarction).
Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease
February 2018, Journal of the American College of Cardiology, Sameer Bansilal et al.
Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 trial.
Three-Year Outcomes With the Absorb Bioresorbable Scaffold
30 January 2018, Circulation, Ziad A. Ali et al.
The Absorb bioresorbable vascular scaffold (BVS) completely resorbs within 3 years after coronary artery implantation. The safety and effectiveness of BVS through this critical 3-year period have not been characterized.
1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor
4 January 2018, Journal of the American College of Cardiology, Zuzana Motovska et al.
Early outcomes of patients in the PRAGUE-18 (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction) study did not find any significant differences between 2 potent P2Y12 inhibitors.
