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NEJM Journal Watch Cardiology Top Stories of 2015
Harlan M. Krumholz, MD, SM
A perspective on the most important research in the field from the past year
This has been another extraordinary year for breakthroughs in cardiology, and I am pleased to provide you with our top stories of the year, chosen by our board of editors.
Leading the way this year is the SPRINT trial, which may ultimately change the way we think about blood pressure targets. For now, the study seems less of a mandate for lower targets than information about the trade-offs involved with more treatment, which, for many patients, will likely seem worth the risks. A report questioning current practices was a randomized trial of patients with atrial fibrillation who were anticoagulated before elective surgery; the results revealed that bridging anticoagulation provided no benefit.
Other studies validated current practices. For example, the IMPROVE-IT trial finally showed that ezetimibe, when added to statin therapy in patients with low LDL-cholesterol levels, could improve outcomes. Aggressive risk factor reduction in patients with atrial fibrillation who underwent ablation produced improvements in weight, blood pressure, blood sugar, and sleep apnea. Complete revascularization for ST-segment elevation myocardial infarction seemed better than a focus on the culprit artery, validating what many interventionalists had long believed despite earlier negative studies. And a liberal or a restricted policy for transfusions after cardiac surgery did not seem to matter, vindicating whichever strategy people are currently using. Prolonged dual platelet inhibition was shown beneficial 3 years after the event.
Some studies on innovative devices and medications held promise for the future. An observational study showed that the leadless pacemaker has promise, although more data are needed. The PCSK-9 studies received a lot of notice, and the drugs were approved. Meanwhile, perhaps next year, we may have a study that tells us whether any of these drugs actually improves clinical outcomes. Regarding a device still under FDA review, left atrial appendage occlusion maintained its benefit in extended follow-up of the PROTECT-AF participants.
We’d like to hear what articles you thought were most important last year. Please let us know by adding a reader comment below. Thanks very much for your continued readership of NEJM Journal Watch Cardiology, and our best wishes for 2016.
Our Cardiology Top Stories of 2015 are:
SPRINT: A Trial of Intensive Blood Pressure Lowering
[The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015 Nov 26; 373:2103. Full-text NEJM article PDF | PubMed® abstract]
[Chobanian AV. Time to reassess blood-pressure goals. N Engl J Med 2015 Nov 26; 373:2093. Full-text NEJM editorial PDF]
Perioperative Anticoagulation in Atrial Fibrillation: A Bridge to Nowhere
[Douketis JD et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015 Aug 27; 373:823. Full-text NEJM article PDF |PubMed® abstract]
Some Improvement in Post-ACS Outcomes with Adjunctive Ezetimibe
[Cannon CP et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015 Jun 18; 372:2387. Full-text NEJM article PDF| PubMed® abstract]
Aggressive Risk Factor Reduction Benefits AF Patients After Ablation
[Pathak RK et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: The ARREST-AF cohort study. J Am Coll Cardiol 2014 Dec 2; 64:2222. PubMed® abstract]
[Kottkamp H. Catheter ablation of atrial fibrillation: On the pathophysiology of the arrhythmia and the impact of cardiac risk factor management. J Am Coll Cardiol 2014 Dec 2; 64:2232. Full-text JACC article online]
Randomized Trial of Complete vs. Culprit-Only PCI in STEMI
[Gershlick AH et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: The CvLPRIT trial. J Am Coll Cardiol 2015 Mar 17; 65:963. Full-text JACC article online in PubMed® Central | PubMed® abstract]
[Bhatt DL. Do we really know the CvLPRIT in myocardial infarction? Or just stent all lesions? J Am Coll Cardiol 2015 Mar 17; 65:973. JACC article preview]
What Is the Optimal Transfusion Threshold After Cardiac Surgery?
[Murphy GJ et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 2015 Mar 12; 372:997. Full-text NEJM article PDF | PubMed® abstract]
[Spertus J. “TITRe”ing the approach to transfusions after cardiac surgery. N Engl J Med 2015 Mar 12; 372:1069. NEJM editorial preview online]
Prolonged Dual Platelet Inhibition in Patients with Prior MI
[Bonaca MP et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015 May 7; 372:1791. Full-text NEJM article PDF |PubMed® abstract]
[Keaney JF. Balancing the risks and benefits of dual platelet inhibition. N Engl J Med 2015 May 7; 372:1854. NEJM editorial preview online]
Leadless Pacemaker Continues to Impress, But Is It Ready for Prime Time?
[Reddy VY et al. Percutaneous implantation of an entirely intracardiac leadless pacemaker. N Engl J Med 2015 Sep 17; 373:1125. PubMed® abstract]
More Promising Results for PCSK9 Inhibitors
[Robinson JG et al. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med 2015 Apr 16; 372:1489. Full-text NEJM article PDF | PubMed® abstract]
[Stone NJ and Lloyd-Jones DM. Lowering LDL cholesterol is good, but how and in whom? N Engl J Med 2015 Apr 16; 372:1564. NEJM editorial preview online]
More Data on Left Atrial Appendage Occlusion
[Reddy VY et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: A randomized clinical trial. JAMA 2014 Nov 19; 312:1988.Full-text JAMA article online | PubMed® abstract]
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