Clinical
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Do We Need to Stop Renin-Angiotensin Inhibition Before Non-Cardiac Surgery?
A randomized study of stopping vs. continuing renin-angiotensin system inhibitors prior to elective non-cardiac surgery in older patients did not decrease the incidence of myocardial injury and may have increased the incidence of hypertensive adverse events.
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Are Beta-Blockers Post-MI Still Necessary?
A large, multicenter, international, randomized clinical trial of long-term beta-blocker therapy vs. no such therapy in contemporary acute myocardial infarction patients who had coronary artery angiography-guided therapy and left ventricular ejection fractions ≥ 50% found no differences in the primary endpoint of all-cause mortality and recurrent myocardial infarction.
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Is Weight Loss the Key to Heart Health?
The second trial of semaglutide in obese patients with heart failure and preserved left ventricular ejection fraction, this one in people with type 2 diabetes, also has shown significant improvements in symptoms and exercise function with significantly fewer adverse effects than placebo-treated patients.
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Transcatheter Myotomy for Left Ventricular Outflow Tract Obstruction
Initial experience with a new transcutaneous transcatheter electrosurgery device using intramyocardial guidewires to create left ventricular upper septum myotomies to enlarge the outflow tract in symptomatic patients with hypertrophic cardiomyopathy, and potentially to enhance transcatheter left heart valve replacement when outflow tract obstruction compromises the procedure, is described in this report from a single center.
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Can Coronary Stenting in Stable Atherosclerotic Coronary Disease Prevent Future Adverse Events?
In this randomized, open-label trial of patients with primarily stable atherosclerotic coronary disease, stenting compared with medical therapy of nonobstructive lesions with imaging markers of plaque vulnerability resulted in a lower incidence of the composite endpoint of cardiac death, target-vessel myocardial infarction, ischemia-driven target vessel revascularization, or hospitalization for unstable or progressive angina at two years.
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Estradiol Valerate-Dienogest and VTE Risk in Combined Oral Contraceptives
A pooled analysis comparing the risk of venous thromboembolism associated with combined oral contraceptives (COC) found significantly decreased venous thromboembolism risk in estradiol valerate-dienogest COCs compared with ethinyl estradiol-levonorgestrel COCs (propensity score-stratified hazard ratio, 0.46; 95% confidence interval, 0.22-0.98).
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Progestins and Meningioma Risk: What Do the Data Say?
The authors of this study sought to determine whether there was a relationship between progestins and central nervous system meningiomas.
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Medication Abortion via Telehealth in the United States
A prospective study of U.S. patients obtaining medication abortion through telehealth platforms demonstrated high effectiveness (97.7%; 95% confidence interval [CI], 97.2% to 98.1%) and safety (99.8%; 95% CI, 99.6% to 99.9%).
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The Role of Probiotics and Synbiotics for Management of Gestational Diabetes
Probiotics and synbiotics have shown promise in reducing insulin resistance and enhancing glycemic control, blood lipid profiles, and inflammation among women with gestational diabetes mellitus (GDM). Although they hold potential as a treatment option for GDM, conclusive recommendations await larger, well-designed randomized controlled trials with extended follow-up periods.
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Which Is the Key Lead?
The patient whose ECG appears in the figure is a middle-aged man who presented to the emergency department with new chest pain. Should the cath lab be activated?