Publications by authors named "Steg P"
Background: Chronic kidney disease (CKD) is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain if a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (Hgb 7-8 g/dL) strategy.
Methods: Among the 3,504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with non-missing creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.
Background: Clinical guidelines have concluded that there are insufficient data to provide recommendations for the hemoglobin threshold for the use of red cell transfusion in patients with acute myocardial infarction (MI) and anemia. After the recent publication of the Myocardial Infarction and Transfusion (MINT) trial, we performed an individual patient-level data meta-analysis to evaluate the effect of restrictive versus liberal blood transfusion strategies.
Methods: We conducted searches in major databases.
Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test.
Background: Patients with recent acute coronary syndrome (ACS) commonly experience chest pain, which affects quality of life even when not due to recurrence of ACS. This post hoc analysis of ODYSSEY OUTCOMES assessed the effect of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, on the incidence of chest pain not due to recurrent ACS.
Methods: Patients with recent ACS ( = 18,894) and elevated atherogenic lipoprotein levels despite optimized statin therapy were randomized to subcutaneous alirocumab or matching placebo every 2 weeks.
Background: Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France.
Methods: For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions.
Background: Accurate bleeding risk stratification after percutaneous coronary intervention (PCI) is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of high bleeding risk patients. We derived and validated a novel bleeding risk score by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.
View Article and Find Full Text PDFBackground: The Multicenter Evaluation of the Duration of Therapy for Thrombosis in Children multinational, randomized clinical trial revealed noninferiority of a 6-week vs 3-month duration of anticoagulation for the treatment of provoked venous thromboembolism (VTE) in patients <21 years old in regard to net clinical benefit at 1 year.
Objectives: To evaluate noninferiority at 2 years.
Methods: Patients whose repeat imaging 6 weeks after VTE diagnosis did not show complete veno-occlusion were randomized to discontinue anticoagulation vs receive a total 3-month course and followed for 2 years for the occurrence of symptomatic recurrent VTE (efficacy outcome) and clinically relevant bleeding (safety outcome).
Background: The management of myocardial infarction without ST segment elevation (NSTEMI) in elderly patients remains challenging, in particular the benefit/risk balance of routine revascularization remains uncertain.
Study Design: EVAOLD is s a multicenter, prospective, open-label trial with 2 parallel arms in NSTEMI patients ≥80 years of age. The aim of the trial is to test whether a strategy of selective invasive management guided by ischemia stress imaging (IMG group) will be noninferior in preventing Major Adverse Cardiac and Cerebrovascular Events (MACCE, ie all-cause death, nonfatal myocardial infarction, nonfatal stroke) rates at 1 year compared with a routine invasive strategy (INV Group).
Article Synopsis
- The study evaluates the impact of early discontinuation of aspirin in favor of ticagrelor monotherapy on bleeding and ischemic events in patients who underwent percutaneous coronary intervention (PCI).
- Results show that while ticagrelor monotherapy led to significantly fewer bleeding events compared to ticagrelor plus aspirin, the total ischemic events remained similar between the two groups.
- Overall, among high-risk PCI patients, ticagrelor alone was associated with reduced bleeding without increasing the risk of ischemic complications.
Purpose Of The Review: This review examines the pivotal role of monoclonal antibodies against PCSK9 in lipid-lowering therapy, emphasizing their biological and clinical impact.
Recent Findings: Randomized controlled trials have validated that PCSK9 monoclonal antibodies (Mabs) effectively reduce LDL-c levels by approximately 50%, even when added to maximal statin therapy. They moreover produce a notable 15-20% relative decrease in major cardiovascular events, with a greater reduction among high-risk patients and no evidence for serious adverse effects, assuaging previous concerns.
Article Synopsis
- - The BRIGHT-4 study showed that using bivalirudin with a high-dose infusion after PCI led to lower overall mortality and bleeding risks compared to heparin, without raising rates of reinfarction or stent thrombosis in STEMI patients.
- - A meta-analysis of six trials involving over 15,000 patients found that while bivalirudin reduced overall and cardiac mortality and major bleeding, it was associated with higher rates of reinfarction and stent thrombosis compared to heparin.
- - When specifically looking at a subset of trials similar to the BRIGHT-4 approach, bivalirudin also showed a decrease in 30-day mortality and major bleeding, with comparable rates of reinfar
Background: The optimal hemoglobin threshold to guide red blood cell (RBC) transfusion for patients with acute myocardial infarction (MI) and anemia is uncertain.
Objective: To estimate the efficacy of 4 individual hemoglobin thresholds (<10 g/dL [<100 g/L], <9 g/dL [<90 g/L], <8 g/dL [<80 g/L], and <7 g/dL [<70 g/L]) to guide transfusion in patients with acute MI and anemia.
Design: Prespecified secondary analysis of the MINT (Myocardial Ischemia and Transfusion) trial using target trial emulation methods.
Article Synopsis
- The study evaluated the PACAS risk model's ability to identify patients at high risk for severe asymptomatic carotid artery stenosis (ACAS) and predict future strokes and cardiovascular disease (CVD) risk.
- It involved 26,384 patients aged 45-80, finding that 6.3% had severe ACAS at baseline and that higher PACAS scores correlated with increased incidences of stroke and CVD over roughly 70,000 patient-years of follow-up.
- The PACAS model was confirmed to effectively discriminate and calibrate risk levels, indicating that patients with higher scores had a significantly higher prevalence of severe ACAS and related events during the follow-up period.
Article Synopsis
- SGLT2 inhibitors like sotagliflozin show promise in improving health status for heart failure patients, but effects of SGLT1/SGLT2 inhibition remain unclear.* -
- In the SOLOIST-WHF trial, patients taking sotagliflozin after a heart failure episode experienced a significant improvement in their Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) scores compared to those on placebo.* -
- Overall, sotagliflozin not only reduced hospitalizations and cardiovascular deaths but also led to improved symptoms and quality of life within four months, benefiting patients regardless of their left ventricular ejection fraction.*
Article Synopsis
- The study investigates the relationship between triglyceride levels and the cardiovascular benefits of alirocumab compared to placebo in patients with recent acute coronary syndrome (ACS) who are on statin therapy.
- Results showed that higher baseline triglyceride levels were linked to an increased risk of major adverse cardiovascular events (MACE), whereas alirocumab significantly lowered LDL cholesterol and reduced MACE risk.
- While alirocumab led to a notable decrease in triglycerides, the reduction did not correlate with a lower risk of MACE, suggesting baseline triglyceride levels are more important for cardiovascular risk than reductions achieved through treatment.
Article Synopsis
- A study was conducted to explore the relationship between snoring, daytime sleepiness, and the risk of developing hypertension among normotensive individuals aged 18 to 69 in France.* -
- Out of nearly 35,000 participants, those who reported habitual snoring and excessive daytime sleepiness had a higher incidence of treated hypertension during a follow-up period of about 3.1 years.* -
- The findings suggest that regular snoring and daytime sleepiness could serve as useful indicators for hypertension risk, indicating that screening for these symptoms might help in preventing high blood pressure.*
Background And Aims: In the AEGIS-II trial (NCT03473223), CSL112, a human apolipoprotein A1 derived from plasma that increases cholesterol efflux capacity, did not significantly reduce the risk of the primary endpoint through 90 days vs. placebo after acute myocardial infarction (MI). Nevertheless, given the well-established relationship between higher low-density lipoprotein cholesterol (LDL-C) and plaque burden, as well as greater risk reductions seen with PCSK9 inhibitors in patients with baseline LDL-C ≥ 100 mg/dL on statin therapy, the efficacy of CSL112 may be influenced by baseline LDL-C.
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- Direct oral anticoagulants are commonly used for preventing strokes in patients with atrial fibrillation and flutter, but concerns about bleeding limit their use; milvexian is a new drug that might work as well with less bleeding risk.
- The LIBREXIA AF trial is a large global study comparing milvexian to apixaban, enrolling 15,500 participants to assess if milvexian can prevent strokes without increasing bleeding events significantly.
- The results from this study aim to clarify the efficacy and safety of milvexian compared to apixaban over a projected 4-year follow-up period.
Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischaemia, various classifications have emerged over time, often with conflicting terminology-e.g.
View Article and Find Full Text PDFSince the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischemia, various classifications have emerged over time, often with conflicting terminology-eg, "stable coronary artery disease" (CAD), "stable ischemic heart disease," and "chronic coronary syndromes" (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with "acute coronary syndromes" (ACS), the 2023 American guidelines endorsed the alternative term "chronic coronary disease.
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- Patients without standard modifiable cardiovascular risk factors (SMuRFs) experience lower in-hospital mortality after a first heart attack compared to those with risk factors, but their long-term outcomes are less understood, especially in women.
- This study analyzed a large cohort of patients with stable coronary artery disease, comparing outcomes based on the presence or absence of SMuRFs over a 5-year period.
- Results showed that SMuRF-less patients had a significantly lower rate of cardiovascular death and non-fatal heart attacks, indicating that having fewer risk factors correlates with better long-term heart health outcomes.
Article Synopsis
- Sudden death is a significant concern following acute myocardial infarction (AMI), and this study compares recent and older patient data from two clinical trials (PARADISE-MI and VALIANT) focusing on sudden death or resuscitated cardiac arrest (RCA).
- The analysis involved roughly 5,661 patients from PARADISE-MI and 9,617 patients from the VALIANT trial's specific cohort, with key demographics indicating a large proportion of male participants and an average age in the mid-60s.
- Results showed a notably higher rate of sudden death/RCA in the VALIANT cohort (7.4%) compared to the PARADISE-MI cohort (2.6%), suggesting a possible improvement in outcomes
Article Synopsis
- Clonal hematopoiesis of indeterminate potential (CHIP) is linked to a higher risk of cardiovascular (CV) disease in general populations, but its impact on patients with existing CV conditions in clinical trials was unclear.
- A study of 63,700 patients from five randomized CV therapy trials found that while CHIP+ patients had a 30% higher risk of a first myocardial infarction (heart attack), their risk for recurrent heart attacks showed no significant increase.
- The research also indicated that CHIP does not significantly affect the effectiveness of standard CV treatments, suggesting that both CHIP+ and CHIP- patients benefit similarly from these therapies.