Cardiology News / Recent Literature Review / Second Quarter 2018

Abstract

ESC Meeting: Munich, 25-29/8/2018

TCT Meeting: San Diego, 21-25/9/2018

Hellenic Cardiological Society Meeting, Athens, 18-20/10/2018

AHA Meeting: Chicago, 10-12/11/2018

EASEL Study: Sodium Glucose Cotransporter 2 Inhibitors (SGLT2i) Confer a Lower Rate of All-Cause Mortality, Hospitalization for Heart Failure (HF), and Major Adverse Cardiovascular Events (MACE)

After propensity matching, 25 258 patients were followed for a median of 1.6 years. Compared with non-SGLT2i, initiation of SGLT2i was associated with a lower rate of all-cause mortality and hospitalization for HF (1.73 vs 3.01 events per 100 person-years; HR, 0.57) and MACE (2.31 vs 3.45 events per 100 person-years; HR, 0.67). SGLT2i initiation was also associated with an ≈2-fold higher risk of below-knee lower extremity amputation (0.17 vs 0.09 events per 100 person-years; HR, 1.99). Because of the disproportionate canagliflozin exposure in the database, the majority of amputations were observed on canagliflozin (Udell JA et al, Circulation 2018;137:1450-9).

In Most Young Patients Who Experienced Sudden Cardiac Arrest (SCA), Sports was a Trigger in a Minority of Cases, while Standard Cardiovascular Risk Factors were Found in Over Half of them

Among 186 SCAs in the young (ages 5-34 years) (5% of all SCAs), overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as non-sports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related vs non-sports SCA (28% vs 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases (Jayaraman R et al, Circulation 2018;137:1561-1570).

Although Second Arterial Conduit Use May be Low and Declining, Arterial Grafts Are Associated with Lower Mortality and Fewer Cardiovascular Events / A Right Internal Mammary Artery (IMA) Graft Offered No Benefit Over that of a Radial Artery, But did Increase Risk of Sternal Wound Infection / Thus, the Radial Artery May be the Preferred Second Conduit

The study included patients who received second arterial (right IMA or radial artery, n=5866) or a venous conduit (n=53 566). Propensity score matching yielded 5813 matched sets. Subgroup analysis compared outcomes between propensity score–matched recipients of a right IMA (n=1576) or a radial artery (n=4290). Use of second arterial conduit use decreased from 10.7% in 2006 to 9.1% in 2011 (P<0.0001). However, receipt of a second arterial conduit was associated with lower mortality (13.1% vs 10.6% at 7 years; hazard ratio-HR, 0.79), and lower risks of MI (HR, 0.78) and repeat revascularization (HR, 0.82). In comparison with radial artery grafts, right IMA grafts were associated with similar mortality rates (10.3% vs 10.7% at 7 years; HR, 1.10) and individual risks of cardiovascular events, but the risk of sternal wound infection was increased (risk difference, 1.07%) (Goldstone AB et al, Circulation 2018;137:1698-1707)... (excerpt)