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Elective Revascularization, Better Long-term Survival: Meta-analysis

  (UPDATED) Looking once again at a question that many cardiologists considered settled, a new meta-analysis suggests that patients with stable coronary artery disease undergoing elective revascularization are at a lower risk of dying from cardiac causes over the long term when compared with patients treated with medical therapy alone. The findings, presented today as a late-breaking clinical trial at EuroPCR 2021, and simultaneously published in the European Heart Journal, seem to fly in the face of the randomized ISCHEMIA trial findings, published last year. In this analysis, the benefit appeared directly related to the duration of follow-up, with investigators reporting that the longer the follow-up, the lower the risk of cardiac death and spontaneous MI among those who underwent PCI or CABG surgery.

Dual Bests Triple Therapy in Nonvalvular AF Patients in RE-DUAL PCI

April 09, 2021 Dropping aspirin soon after PCI seems to be the best strategy for preventing bleeding in high-risk patients with nonvalvular atrial fibrillation (AF), according to a landmark analysis of the RE-DUAL PCI trial. As reported by TCTMD, RE-DUAL PCI supported moving away from a triple-therapy strategy P2Y12 inhibitor, warfarin, and aspirin in these patients in order to lessen bleeding without increasing the risk of thrombotic events. The new data in conjunction with the rest of the available evidence, including those from AUGUSTUS, “are pretty clear that that strategy of prolonged triple therapy almost should never be used,” study co-author Deepak L. Bhatt, MD, MPH (Brigham and Women’s Hospital, Boston, MA), told TCTMD. “Our article sort of helps bring some granularity to the sort of minimum duration of aspirin that s probably needed.”

Observational Study Supports Continuing Oral Anticoagulation During PCI

April 06, 2021 For patients sent for an unplanned PCI, a strategy of maintaining oral anticoagulation is not associated with a higher risk of ischemic complications or bleeding when compared with a strategy of interrupting the direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA) a day or two before the procedure, a new observational analysis confirms. Published in the April 12, 2021, issue of JACC: Cardiovascular Interventions, the study, drawing on the large SWEDEHEART registry, supports the current recommendations from the European Society of Cardiology (ESC) for uninterrupted oral anticoagulation (U-OAC) in patients with atrial fibrillation, venous thromboembolism, or a mechanical heart valve undergoing unplanned, nonemergent PCI, investigators say.

Antithrombotics for Elderly CAD Patients: One Size Doesn't Fit All

Popularity vs Reputation: Content Matters for #CardioTwitter