Assessing the Safety of Early Repatriation for Stable ST-Segment Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention.

Background: Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients.

Methods: Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included.

Diagnostic Accuracy of Transthoracic Echocardiography With Contrast for Detection of Right-to-Left Shunt: A Systematic Review and Meta-analysis.

Background: The clinical utility of transthoracic echocardiography with contrast (TTE-C) for detection of right-to-left shunt (RLS) remains unknown. In this meta-analysis we evaluated the accuracy of TTE-C for RLS diagnosis compared with transesophageal echocardiography (TEE) as the reference standard.

Methods: A systematic review and meta-analysis was performed using a search of MEDLINE, EMBASE, PubMed, and Cochrane library databases.

Provision of a DAPT Score to Cardiologists and Extension of Dual Antiplatelet Therapy Beyond 1 Year After ACS: Randomized Substudy of the Prospective Canadian ACS Reflective II Study.

Background: Extension of dual antiplatelet therapy (DAPT) beyond 1 year after acute coronary syndrome is associated with a reduction in ischemic events but also increased bleeding. The DAPT score identifies individuals likely to derive overall benefit or harm from DAPT extension. We sought to evaluate the impact of providing the DAPT score to treating physicians on the decision to extend DAPT beyond 1 year after non-ST-segment elevation myocardial infarction.

Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients With Atrial Fibrillation: Findings From the CONNECT AF+PCI Study.

Background: In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), selecting an antithrombotic regimen requires balancing risks of ischemic cardiac events, stroke, and bleeding.

Methods: We studied 467 patients with AF undergoing PCI in the time period from December 2015 to July 2018 identified via a chart audit by 47 Canadian cardiologists in the CONNECT AF+PCI (the ordinated ational etwork to ngage Interventional ardiologists in the Antithrombotic reatment of Patients With trial ibrillation Undergoing ercutaneous oronary ntervention) study, to determine patterns of initial antithrombotic therapy selection.

Results: The median (25th, 75th percentile) CHADS score was 2 (1, 3), and PCI was performed in the setting of acute coronary syndrome in 62.

Use of antithrombotic therapy for secondary prevention in patients with stable atherosclerotic cardiovascular disease: Insights from the COordinated National Network to Engage Cardiologists in the antithrombotic Treatment of patients with CardioVascular Disease (CONNECT-CVD) study.

Background: Although acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada.

Methods: Canadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy-like criteria from May 2018 to April 2019.

Drug Adherence and Long-Term Outcomes in Non-Revascularized Patients Following Acute Myocardial Infarction.

This study examined long-term outcomes and adherence to guideline-based medications in non-revascularized acute myocardial infarction (MI) patients undergoing and not undergoing angiography. We analyzed non-revascularized MI patients hospitalized in Alberta, Canada between 2010-2016 and categorized them according to whether they had undergone coronary angiography. Adherence to guideline-based medications was determined by the proportion of days covered (PDC) and subdivided into categories based on PDC: 0% (none), 1-40% (low), 40-79% (intermediate) and ≥ 80% (high).

Contemporary use of guideline-based higher potency P2Y12 receptor inhibitor therapy in patients with moderate-to-high risk non-ST-segment elevation myocardial infarction: Results from the Canadian ACS reflective II cross-sectional study.

Background: After myocardial infarction, guidelines recommend higher-potency P2Y12 receptor inhibitors, namely ticagrelor and prasugrel, over clopidogrel.

Hypothesis: We aimed to determine the contemporary use of higher-potency antiplatelet therapy in Canadian patients with non-ST-elevation myocardial infarction (NSTEMI).

Methods: A total of 684 moderate-to-high risk NSTEMI patients were enrolled in the prospective Canadian ACS Reflective II registry at 12 Canadian hospitals and three clinics in five provinces between July 2016 and May 2018.

Examining the evidence for PFO closure and novel oral anticoagulants for treatment of cryptogenic stroke.

: There has been considerable study assessing the treatment of cryptogenic stroke (CS) recently. This review examines the role of patent foramen ovale (PFO) closure in CS, while also discussing the evidence for alternative medical therapies in disease treatment.: PFO closure for treatment of CS has been assessed in 6 randomized controlled trials (RCTs).

Examining the Role of and Treatment Directed at IL-1β in Atherosclerosis.

Purpose: The purpose of this review was to examine the role of IL-1β in the inflammatory process central to the development of atherosclerosis and to discuss current clinical evidence for treatments targeting IL-1β in coronary artery disease.

Recent Findings: IL-1β has been shown to modulate atherosclerotic plaque progression by upregulating the synthesis of adhesion molecules on endothelial cells, as well increasing activation and proliferation of vascular smooth muscle cells. Animal studies have further suggested that alterations in the balance between agonists and antagonists of IL-1β are important in promoting atherosclerosis.

Cost consequence analysis of use of a balloon expandable vascular access system and standard vascular sheath for transcatheter aortic valve implantation.

Background: Vascular complications are an important complication of transcatheter aortic valve implantation and are associated with increased morbidity and mortality as well as cost. The Solopath device is an expandable vascular access system that has previously been shown to be associated with lower rates of vascular complications. This study sought to evaluate the impact of the use of this system on vascular complications and costs in a decision model analysis.

Efficacy of a balloon-expandable vascular access system in transfemoral TAVI patients.

Background: Vascular complications (VC) are a serious and frequent complication of transfemoral transcatheter aortic valve implantation (TAVI) and result in increased morbidity and mortality. It has been suggested that newly developed vascular sheaths may increase the ability to perform transfemoral TAVI in patients with normal and access-limiting peripheral artery disease (PAD) and reduce vascular complications.

Aims: We sought to assess the safety and efficacy of the 19 French (F) SoloPath balloon-expandable transfemoral vascular access system in patients who underwent transfemoral TAVI at our center between 2011 and 2014.

Impact of left ventricular function on clinical outcomes of functional mitral regurgitation patients undergoing transcatheter mitral valve repair.

Objectives: To evaluate the impact of baseline left ventricular (LV) function on the clinical outcomes of patients with functional mitral regurgitation (FMR) treated with MitraClip.

Background: It is unknown whether patients with significant FMR and severe LV dysfunction benefit from MitraClip.

Methods: A cohort of 77 patients with significant FMR undergoing MitraClip procedure between December 2010 and January 2015 was categorized by baseline LV ejection fraction (LVEF) into tertiles: LVEF <27% (n = 27), LVEF 27-37% (n = 25), and LVEF >37% (n = 25).

Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention.

Objectives: This study sought to assess the impact of residual coronary artery disease (CAD), using the residual SYNTAX score (rSS), on in-hospital outcomes after primary percutaneous intervention (PPCI). The study also aimed to determine independent predictors for high rSS. Residual CAD has been associated with worsened prognosis in patients undergoing PCI for non-ST acute coronary syndromes.

Characterising and predicting bleeding in high-risk patients with an acute coronary syndrome.

Objective: In the Apixaban for Prevention of Acute Ischemic Events (APPRAISE-2) trial, the use of apixaban, when compared with placebo, in high-risk patients with a recent acute coronary syndrome (ACS) resulted in a significant increase in bleeding without a reduction in ischaemic events. The aim of this analysis was to provide further description of these bleeding events and to determine the baseline characteristics associated with bleeding in high-risk post-ACS patients.

Methods: APPRAISE-2 was a multinational clinical trial including 7392 high-risk patients with a recent ACS randomised to apixaban (5 mg twice daily) or placebo.

Novel anti-inflammatory therapies for the treatment of atherosclerosis.

The underlying role of inflammation in atherosclerosis has been characterized. However, current treatment of coronary artery disease (CAD) predominantly consists of targeted reductions in serum lipoprotein levels rather than combating the deleterious effects of acute and chronic inflammation. Vascular inflammation acts by a number of different molecular and cellular pathways to contribute to atherogenesis.

Effect of radial-to-femoral access crossover on adverse outcomes in primary percutaneous coronary intervention.

We aimed to describe the impact of the vascular access used when patients are treated with primary percutaneous coronary intervention (PPCI) and to assess whether this translates into differences in angiographic outcomes. Patients with ST-elevation myocardial infarction who underwent PPCI were divided into 3 groups: successful radial access (RA), successful femoral access (FA), and Crossover (failed RA with need for bailout FA) groups. Vascular access-related time (VART) was defined as the delay in PPCI that can be attributed to vascular access-related issues.

Transradial percutaneous coronary interventions in acute coronary syndrome.

Transradial access (TRA) is becoming increasingly used worldwide for percutaneous coronary intervention (PCI) after acute coronary syndromes (ACS). TRA compared with transfemoral access has been noted to improve clinical outcomes in clinical trials and large registry cohort studies. However, much of the benefits of TRA PCI are noted in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI, where TRA PCI has been associated with reductions in major bleeding events and potentially lower short- and long-term mortality rates.

Myocardial fibrosis and quality of life in patients with non-ischemic cardiomyopathy: a cardiovascular magnetic resonance imaging study.

Myocardial fibrosis (MF) is a common pathophysiologic endpoint in non-ischemic cardiomyopathy and may be identified by late gadolinium enhancement (LGE) MRI. While associated with future cardiovascular events in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) the influence of MF on interim quality of life (QOL) has not been explored. In this study we investigate for associations between MF and validated indices of QOL in patients with HCM and DCM.

Evaluation of coronary allograft vasculopathy using multi-detector row computed tomography: a systematic review.

Coronary allograft vasculopathy (CAV) is a significant cause of morbidity and mortality after cardiac transplantation and requires frequent surveillance with catheter-based coronary angiography (CCA). Multi-detector row computed tomography (MDCT) has been shown to be effective in assessing atherosclerosis in native coronary arteries. This article systematically reviews the literature to determine the accuracy of MDCT in CAV assessment.

Transitioning from 16-slice to 64-slice multidetector computed tomography for the assessment of coronary artery disease: are we really making progress?

Background: Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease.

Objective: To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT.

Methods: An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words 'computed tomography' matched with the terms 'coronary artery' or 'coronary angiography' to identify English-language articles examining MDCT cardiac imaging.

Ventricular proarrhythmic effects of atrial fibrillation are modulated by depolarization and repolarization anomalies in patients with left ventricular dysfunction.

Background: Atrial fibrillation (AF) may have a ventricular proarrhythmic effect, particularly in the setting of heart failure. We assessed whether AF predicts appropriate implantable cardioverter-defibrillator (ICD) shocks in patients with left ventricular dysfunction and explored modulators of risk.

Methods And Results: A retrospective cohort study was conducted on 215 consecutive patients with ICDs for primary prevention having a left ventricular ejection fraction < or = 35%.

Abetalipoproteinemia: two case reports and literature review.

Abetalipoproteinemia (ABL, OMIM 200100) is a rare, autosomal recessive disorder, characterized by fat malabsorption, acanthocytosis and hypocholesterolemia in infancy. Later in life, deficiency of fat-soluble vitamins is associated with development of atypical retinitis pigmentosa, coagulopathy, posterior column neuropathy and myopathy. ABL results from mutations in the gene encoding the large subunit of microsomal triglyceride transfer protein (MTP; OMIM 157147).