by ImagicaHealth
Want to hear the latest in cardiology research, reviews, and perspectives? Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Our summaries are available monthly.
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May 1, 2025
<p><strong>Does Timing of Coronary Artery Bypass Grafting after ST-Elevation Myocardial Infarction Impact Early- and Long-Term Outcomes?</strong></p><p><strong>DOI: 10.1055/s-0044-1787851</strong></p><p><strong> Abstract</strong></p><p><strong>Background: </strong>The optimal timing of surgicalrevascularization after ST-elevation myocardial infarction (STEMI) is controversial, with some suggesting higher mortality rates in patients undergoing early surgery. The aim of the study is to determine the effect of the timing of surgical revascularization on 30-day mortality and long-termoutcomes in these patients.</p><p><strong>Methods: </strong>Retrospective single-center analysis ofpatients with ST-elevation myocardial infarction undergoing coronary artery bypass grafting (CABG) between January 2008 and December 2019 at our institution. The cohort was split into three groups based on time from symptomonset until surgical revascularization (Group 1: <12 hours, Group 2: 12-72 hours, Group 3: >72 hours). Statistical analyses were performed with and without patients in cardiogenic shock. Primary outcomes were 30-day mortality and10-year survival.</p><p><strong>Results: </strong>During the study period, 437 consecutive patients underwent surgical revascularization in the setting ofSTEMI. The mean age was 67.0 years, 96 (22.0%) patients were female, and 281 (64.3%) patients underwent off-pump CABG. The overall 30-day mortality includingpatients with cardiogenic shock was 12.8%. The 30-day mortality was 16.1, 13.9, and 9.3% in Groups 1, 2, and 3 (p = 0.31), whereas 10-year survival was 48.5, 57.3,and 54.9% (log-rank: p =0.40). After exclusion of patients in cardiogenic shock, there was no difference between the three groups in 30-day and 10-year mortality. Timing ofsurgery had no influence on early- and long-term survival.</p><p><strong>Conclusion: </strong>In patients with ST-elevationmyocardial infarction, early surgical revascularization achieved similar early- and long-term survival rates compared with a delayed surgical revascularizationstrategy. Hence, when indicated, an early coronary artery bypass grafting strategy has no disadvantages in comparison to a delayed strategy.</p><p> <strong>Disclaimer:</strong></p><p>Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.</p><p></p>
May 1, 2025
<p><strong>Rationale and Design of the TADCLOT Trial: A Double Blind Randomized Controlled Trial Comparing Twice a DayClopidogrel vs. Ticagrelor in Reducing Major Cardiac Events in Patients with Acute STEMI Undergoing Primary Percutaneous Coronary Intervention</strong><br><strong>DOI: 10.1016/j.ahj.2025.03.021</strong></p><p><strong> Abstract</strong></p><p><strong>Background: </strong>Ticagrelor has been proven superior toclopidogrel in reducing adverse cardiovascular events in patients with acute coronary syndrome (ACS), yet economic factors often favor clopidogrel in real-world clinical practice. Although double dose clopidogrel has shownpotential benefits over once-daily regimens, its direct comparison with ticagrelor in ST-elevation myocardial infarction (STEMI) patients remains unexplored.</p><p><strong>Methods and design:</strong> Twice a Day Clopidogrel vs.Ticagrelor in Reducing Major Cardiac Events in Patients with Acute STEMI Undergoing Primary PCI (TADCLOT) trial is a double-blind, randomized controlled trial conducted at the National Institute of Cardiovascular Diseases (NICVD),Karachi, Pakistan. It is designed as a superiority trial to evaluate the efficacy and safety of ticagrelor over twice-daily clopidogrel in reducing major adverse cardiac events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Following successful PCI for STEMI, and when the patient is deemed suitable for discharge, patients are randomized 1:1 to receive either ticagrelor (180 mg loading dose followed by 90 mg BID for30 days) or clopidogrel (600 mg loading dose followed by 75 mg BID for 30 days). The primary endpoint is the rate of major adverse cardiac events (MACE), a composite of death, myocardial infarction, stent thrombosis, target lesionrevascularization, or stroke at 30 days following randomization. Secondary endpoints include the individual components of MACE, bleeding complications, and drug discontinuation due to adverse events. Enrollment has reached 88%, with 2,200 patients planned to complete the trial.</p><p><strong>Implications:</strong> The TADCLOT trial will provide crucialinsights into the comparative efficacy of ticagrelor versus twice-daily clopidogrel in reducing early stent thrombosis and improving outcomes in STEMI patients undergoing primary PCI. The trial will particularly contributevaluable insights for post-PCI care, considering both the economic and genetic context of the high risk South Asian population.</p><p><strong>Disclaimer:</strong></p><p>Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.</p><p></p><p></p>
May 1, 2025
<p><strong>In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiate</strong></p><p><strong>DOI: 10.1016/j.jclinane.2025.111824</strong></p><p><strong> Abstract</strong></p><p><strong>Background:</strong> The use of beta-blockers during hospitalization for acute heart failure (AHF) remains controversial. This study aimed to investigate whether beta-blocker use isassociated with a reduced risk of mortality in critically ill patients with AHF and to determine the optimal timing for initiating beta-blocker therapy.</p><p> <strong>Methods</strong>: Data from critically ill patients with AHF in the MIMIC-IV version 2.2 database were analyzed.Baseline characteristics, laboratory tests, comorbidities, vital signs, and medication usage at admission and during hospitalization were collected to performinverse probability of treatment weighting (IPTW). IPTW-weighted logistic regression models were then used to examine the relationship between beta-blocker use and mortality.</p><p> <strong>Results:</strong> In the IPTW-weighted regression model, patients who newly started beta-blockers or continued theiruse had a lower risk of in-hospital mortality compared to those not treated with beta-blockers (oddsratio [OR]: 0.45; 95 % confidence interval [CI]: 0.34 to 0.61, and OR: 0.53; 95 % CI: 0.41 to 0.69, respectively). Conversely, those who had beta-blockers withdrawn showed a higher risk of in-hospital mortality (OR: 2.59; 95 % CI: 1.63 to4.10). Among beta-blocker users, compared to patients treated before admission and who received their first dose within 48 h of admission, those whowere not treated before admission but started after 48 h had a similar mortality risk (OR: 0.82; 95 % CI: 0.60 to 1.11; P = 0.202). However, patients previously treated with beta-blockers who initiated therapy after 48 h and those not treated before admission but started within 48 h had a lower risk of in-hospital mortality (OR: 0.44; 95 % CI: 0.30 to 0.64; P < 0.001, and OR: 0.65; 95 % CI: 0.48 to 0.86; P = 0.003,respectively).</p><p> <strong>Conclusion:</strong> The use of beta-blockers during hospitalization for AHF is associated with a reduced risk of in-hospital mortality, and withdrawal was associated with an increased risk of mortality. Initiating beta-blockers within 48 h for beta-blocker-naïve patients and after 48 h for those previously treated with beta-blockers before admission may further decrease mortality risk.</p><p> <strong>Disclaimer:</strong></p><p>Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.</p><p></p><p></p>
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