Archive for August 2012

No benefit of clopidogrel added to ASA after lacunar infarct

In this large randomized trial of patients with a recent lacunar infarct, the addition of clopidogrel to ASA did not reduce the risk of recurrent stroke, but the risk of major bleeding was twice as high (2% vs 1% per year). There is no benefit, and there is harm, when clopidogrel is added to ASA after lacunar infarct (abstract)

PCI for stable CAD with low fractional flow reserve

In this large trial of patients with stable CAD, those with a fractional flow reserve (FFR) of <80% (which indicates functionally significant stenosis), they were randomized to medical therapy or PCI; PCI had a significantly lower rate of death/MI/urgent revascularization compared to medical therapy (4% vs 13%). In patients with stable CAD and FFR<80%, PCI is beneficial (abstract)

Restenosis of CEA versus carotid stent

In this large randomized trial (CREST trial) of patients with carotid stenosis who underwent either CEA or carotid stenting, the rate of restenosis at 2 years was ~6% in both groups, indicating both procedures are reasonable in short and long term outcomes (abstract)

HAS-BLED outperforms other predictors of bleeding

In this large cohort of anticoagulated Afib patients, HAS-BLED performed the best in predicting clinically relevant bleeding, compared to HEMORR2HAGES or ATRIA, with receiver-operating characteristic (ROC) scores of 0.60, 0.55, and 0.50 respectively. HAS-BLED is the best to date risk score for predicting bleeding in anticoagulated Afib patients (abstract)

New MI definition

Based on consensus from the American College of Cardiology, American Heart Association, European Society of Cardiology, and World Heart Federation has now defined AMI as a cardiac troponin (I or T) level > 99th%, and 1+ of the following (abstract): ischemia symptoms new ST/T wave changes or LBBB new pathologic Q waves new nonviable myocardium or regional wall motion abnormality on imaging intracoronary thrombus on angiography or autopsy.