Aortic valve replacement today: Outcomes, costs, and opportunities for improvement.

The introduction of transcatheter aortic valve replacement (TAVR) just two decades ago has transformed the treatment of severe symptomatic aortic stenosis. TAVR has not only extended the option of aortic valve replacement to patients deemed ineligible for surgery, it has also demonstrated similar or better short- and intermediate-term clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients at all levels of surgical risk. These benefits have been achieved with similar or lower costs compared with SAVR, at least in the first 1-2 years for intermediate- and low-risk patients.

Dynamic TIMI risk score for STEMI.

Background: Although there are multiple methods of risk stratification for ST-elevation myocardial infarction (STEMI), this study presents a prospectively validated method for reclassification of patients based on in-hospital events. A dynamic risk score provides an initial risk stratification and reassessment at discharge.

Methods And Results: The dynamic TIMI risk score for STEMI was derived in ExTRACT-TIMI 25 and validated in TRITON-TIMI 38.

Role of clopidogrel in managing atherothrombotic cardiovascular disease.

Aspirin is the most widely used antiplatelet agent for preventing and treating vascular events. The thienopyridine derivatives, ticlopidine and clopidogrel, are a suitable alternative in patients who are intolerant to aspirin, and clopidogrel exhibits better tolerability than ticlopidine. The available evidence from randomized trials indicates that dual therapy with clopidogrel and aspirin is modestly but significantly more effective than aspirin in preventing serious vascular events.