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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes

Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.¹ To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.

Intravenous Fluids in Patients With Acute Heart Failure

MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.

Risk of Stroke with Intracardiac Devices and Patent Foramen Ovale

After some case reports of stroke due to electrophysiology (EP) device thrombosis in patients with a patent foramen ovale (PFO), concern has been raised about the risk of stroke with intracardiac devices in patients with known PFO. Thus, these investigators from the Cleveland Clinic did a retrospective database study of 2921 echocardiography-detected PFO patients and categorized them as having an EP device (231) or not.

Late Tricuspid Regurgitation After Heart Valve Surgery

Due to the success of left heart valve disease surgical corrections, patients may experience late tricuspid regurgitation.

Coronary Stents and Noncardiac Surgery

Contemporary data suggest that approximately one in every five patients will require non-cardiac surgery within two years of coronary stent implantation.

Spironolactone & the Potential Benefit for HFPEF Patients

No treatment has been shown to improve outcomes in heart failure with preserved ejection fraction.

Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?

Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.

Interventional vs Conservative Strategy for Non-ST Elevation Acute Coronary Syndrome

More recent trials, and meta-analyses of all trials, have shown a reduction in death and myocardial infarction (MI) with a routine invasive strategy vs an ischemia or symptom-driven invasive strategy over 6-24 months for patients with non-ST elevation (E) acute coronary syndrome (ACS). However, an increase in death during the initial hospitalization in the routine invasive arm makes long-term outcome data important. Thus, the British Heart Foundation RITA 3 trial 5-year data are of interest.

Dual Therapy for Acute STEMI: Has The Time Arrived?

In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications.

Reversal of Cardiomyopathy in Patients With Repetitive Ventricular Ectopy

Arrhythmia is the primary problem rather than a marker of an underlying cardiomyopathy.