A listener defends colored boxes in guidelines; mysteries of non-culprit coronary lesions during PCI, and of AF ablation; and surrogate markers are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Mystery of What to Do in the Cath Lab after Fixing the Culprit Lesion – The FULL REVASC Trial

Complete Revascularization Not Superior to Culprit-Only PCI After MI

https://www.medscape.com/viewarticle/complete-revascularization-not-superior-culprit-only-pci-2024a10007ik

• FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149
• FIRE Trial https://www.nejm.org/doi/10.1056/NEJMoa2300468
• COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775
• Cohen Tweet on FULL REVASC https://x.com/djc795/status/1781361606238085532

II. AF Ablation Mysteries

New Expert Consensus on Ablation Strategies for AF

https://www.medscape.com/viewarticle/new-expert-consensus-ablation-strategies-af-2024a1000851

• Bern Study of Remapping https://doi.org/10.1016/j.jacep.2024.02.026
• Natural History of SCAF https://doi.org/10.1016/j.jacc.2019.09.050
• Liverpool Study: Thermal PV Isolation in Persistent AF https://doi.org/10.1016/j.hrthm.2024.04.061

III. Surrogate Markers

• JAMA: Surrugate Markers and Clinical Outcomes https://jamanetwork.com/journals/jama/fullarticle/2817850
• BP Surrogate Meta-analysis https://doi.org/10.1016/S0140-6736(21)00590-0
• JAMA: Nonfatal MI as Surrogate for Mortality https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560

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ACC Part 2: The TACT2 trial of chelation, inter-atrial shunts for HF, and triglyceride lowering; plus diltiazem and Factor Xa anticoagulants are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. TACT 2

Chelation Therapy Provides No Benefit Post-MI

https://www.medscape.com/viewarticle/chelation-therapy-provides-no-benefit-post-mi-2024a10006l5

Chelation Therapy and CV Risk: Why TACT2 Showed No Benefit https://www.medscape.com/viewarticle/chelation-therapy-and-cv-risk-why-tact2-showed-no-benefit-2024a1000761?src=

• JAMA TACT 1 paper https://jamanetwork.com/journals/jama/fullarticle/1672238
• Diabetes Subgroup paper https://pubmed.ncbi.nlm.nih.gov/24254885/
• A New Look at P-values https://evidence.nejm.org/doi/abs/10.1056/EVIDoa2300003
• PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655

II. Interatrial Shunts for HF

No Net HF Benefit for Interarterial Shunt Device

https://www.medscape.com/viewarticle/no-net-hf-benefit-interarterial-shunt-device-2024a10006kk

• REDUCE LAP HF II https://doi.org/10.1016/S0140-6736(22)00016-2

III. Triglyceride Lowering

Early Olezarsen Results Show 50% Reduction in Triglycerides

https://www.medscape.com/viewarticle/early-olezarsen-results-show-50-reduction-triglycerides-2024a10006oz

Is It Time to Stop Treating High Triglycerides?

https://www.medscape.com/viewarticle/990126

• NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2402309

Substantial Triglyceride Reduction With Plozasiran

https://www.medscape.com/viewarticle/substantial-triglyceride-reduction-plozasiran-2024a10006wf?icd=login_success_email_match_norm

• JAMA Cardiology https://jamanetwork.com/journals/jamacardiology/article-abstract/2817469

IV. Diltiazem and Factor Xa inhibitors

• JAMA Vanderbilt University Paper https://jamanetwork.com/journals/jama/fullarticle/2817546

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ACC Recap #1: DanGer Shock (plus a sobering JAMA research letter on Impella use), REDUCE-AMI, PREVENT, and EMPACT-MI are the topics John Mandrola, MD, covers in this week’s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. DanGer-Shock Trial

Impella CP Improves Survival in STEMI, Cardiogenic Shock https://www.medscape.com/viewarticle/impella-cp-improves-survival-stemi-cardiogenic-shock-2024a10006kz

Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659

• Published DanGer Shock Study  https://www.nejm.org/doi/full/10.1056/NEJMoa2312572
• JAMA Research letter https://jamanetwork.com/journals/jama/article-abstract/2817457

II. REDUCE-AMI Trial

New Data Question Beta-Blockers Post-MI With Preserved EF https://www.medscape.com/viewarticle/new-data-question-beta-blockers-post-mi-preserved-ef-2024a10006y8

Beta-Blockers Post-MI Past Their Expiration Date: REDUCE-AMI https://www.medscape.com/viewarticle/1000663

• REDUCE-AMI paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401479
• Meta-analysis: Beta Blockers for MI https://doi.org/10.1016/j.amjmed.2014.05.032

III. PREVENT Trial

Preventive PCI for Vulnerable Plaques Reduces Cardiac Events

https://www.medscape.com/viewarticle/preventive-pci-vulnerable-plaques-reduces-cardiac-events-2024a10006tc

Preventive Coronary Stents: Not There Yet

https://www.medscape.com/viewarticle/preventive-coronary-stents-not-there-yet-2024a10006yr

• PREVENT https://doi.org/10.1016/S0140-6736(24)00413-6

IV. EMPACT MI trial of Empagliflozin in the Post-MI setting

Empagliflozin Fails to Reduce Events After Acute MI

https://www.medscape.com/viewarticle/empagliflozin-fails-reduce-events-after-acute-mi-2024a10006kn

• EMPACT-MI: Another SGLT2 Inhibitor Miss in Post-MI Care  https://www.medscape.com/viewarticle/1000684
• EMPACT MI https://www.nejm.org/doi/10.1056/NEJMoa2314051
• DAPA MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286
• PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508
• Kaul thread https://x.com/kaulcsmc/status/1776611935842165029
• Kaul paper https://www.ahajournals.org/doi/full/10.1161/circulationaha.116.022537

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Statins and diabetes, AAD in patients with heart disease, tricuspid valve interventions, and an ACC preview are the topics John Mandrola, MD, discusses in this week’s podcast.This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Statins and Diabetes

• Meta-analysis in Lancet-Diabetes https://doi.org/10.1016/S2213-8587(24)00040-8
• Editorial https://doi.org/10.1016/S2213-8587(24)00059-7
• NEJM Paper on Gene Variants and DM https://www.nejm.org/doi/full/10.1056/nejmoa1604304
• JAMA Paper on Gene Variants and DM https://jamanetwork.com/journals/jama/fullarticle/2565289

II. Anti-arrhythmic Drugs in Patients With Serious Heart Disease

• UPenn Paper on AADs for PVC Suppression https://doi.org/10.1016/j.jacep.2024.01.021
• Three Questions for Evidence-Based Cardiac EP https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381
• CAST trial https://www.nejm.org/doi/full/10.1056/NEJM199103213241201

III. Tricuspid Valve Interventions

FDA Clears TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-clears-triclip-tricuspid-regurgitation-2024a100068o

FDA Panel in Favor of TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-panel-favor-triclip-tricuspid-regurgitation-2024a100037n

• Slides for Trisend II
• TRILUMINATE https://www.nejm.org/doi/full/10.1056/NEJMoa2300525

IV. ACC Preview

Mandrola's Three Trials to Look for at the 2024 American College of Cardiology Scientific Sessions

https://www.medscape.com/viewarticle/1000613

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Intermittent fasting, anticoagulation decisions, heterogenous treatment effects, frailty in HF, the importance of the ECG, and industry conflicts are the topics John Mandrola, MD, covers this week.

This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Intermittent Fasting

No, Intermittent Fasting Won't Kill You

https://www.medscape.com/viewarticle/1000544

• NEJM Paper on Time-Restricted Eating  https://www.nejm.org/doi/full/10.1056/NEJMoa2114833
• JAMA TREAT Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095

II. Stroke Prevention with OAC

• Shah Meta analysis of Vitamin K Agonists in AF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010269

III. Heterogenous Treatment Effects in Trials

Pivotal CV Trials May Not Apply to Complex Patients

https://www.medscape.com/viewarticle/989129

• Analysis of 8 Trials of Multimorbidity and Treatment Response https://doi.org/10.1016/j.amjmed.2024.01.028

IV. Frailty and HF

• Circulation Outcomes: Multidomain Frailty and Mode of Death in HF  https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010416

V. ECG in LBBB

• JAMA Cardiology: Revised Definition of LBBB  https://jamanetwork.com/journals/jamacardiology/fullarticle/2816973

VI. Industry Payments to Doctors

• JAMA: Payments to US Physicians by Specialty https://jamanetwork.com/journals/jama/fullarticle/2816900

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p>Obesity drugs as ASCVD-modifiers, HR monitors, when journals publish obvious facts, and effect scores and sorting out signals from RCTs are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Denmark Notes

II. FDA approval of Semaglutide

FDA Approves Semaglutide for Cardiovascular Risk Reduction

https://www.medscape.com/viewarticle/fda-approves-semaglutide-cardiovascular-risk-reduction-2024a10004ix

• Select Trial

III. PPG Monitor Accuracy

• Research Letter https://doi.org/10.1016/j.jacc.2024.01.024

IV. AAD and Bradycardia

Anti-arrhythmic Drugs Linked to Bradycardia in Patients With AF

https://www.medscape.com/viewarticle/anti-arrhythmic-drugs-linked-bradycardia-patients-af-2024a10004vw

• JACC paper on AAD Adverse Effects https://doi.org/10.1016/j.jacc.2024.01.013

V. Finding Signals in RCTs  

• JAMA paper on Treatment Effects of Oxygen Targets
• DANISH trial https://www.nejm.org/doi/full/10.1056/nejmoa1608029
• LAFFLIN et al. Scoring System to Assess Generalizability of Trial Results https://doi.org/10.1177/2047487318815967

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Plastics and heart disease, MINT trial letters-to-the-editor and Bayes theorem, and Brugada syndrome are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Plastics and Heart Disease

Plastic Particles in Carotid Plaques Linked to CV Events

https://www.medscape.com/viewarticle/plastic-particles-carotid-plaques-linked-cv-events-2024a10004ge

• Plastics and ASCVD Study https://www.nejm.org/doi/full/10.1056/NEJMoa2309822
• Review https://www.nejm.org/doi/full/10.1056/NEJMra2300476
• Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2400683

II. MINT trial LTE and Bayes Theorem

In MI With Anemia, Results May Favor Liberal Transfusion: MINT https://www.medscape.com/viewarticle/998376

• The MINT Study https://www.nejm.org/doi/full/10.1056/NEJMoa2307983
• Letter-to-the-Editor https://www.nejm.org/doi/full/10.1056/NEJMc2400982
• Likelihood Ratio https://www.cebm.ox.ac.uk/resources/ebm-tools/likelihood-ratios

III. Brugada Syndrome

The EHJ paper: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae133/7623123

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The Western AF meeting, aspirin, cannabis use, LVEF in athletes, and shared decision making before ICD implantation are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. ASA in Primary Prevention

• Campbell Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065420
• Swedish Observational study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.028321
• ASPREE https://www.nejm.org/doi/full/10.1056/NEJMoa1805819

II. Cannabis

Cannabis Use Tied to Increased Cardiovascular Risk

https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr

It Sure Looks Like Cannabis Is Bad for the Heart, Doesn’t It?

https://www.medscape.com/viewarticle/1000250

• Journal of the AHA Observational Study https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030178

III. Low EF in Athletes

• Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063777

IV. ICDs and Shared Decision-Making

• Association of a Medicare Mandate for Shared Decision-Making With Cardiac Device Utilization https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2815017

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Reading incidental CAC on chest CT scans, exercise benefits in women vs men, PCI with or without imaging, and trial non-reporting are the topics John Mandrola, MD, discusses in this week’s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Incidental CAC on Chest CT

• Incidental CAC
• Tweet
• When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry https://doi.org/10.1016/j.jcmg.2023.03.008

II. Exercise

Health Gains of Exercise Greater in Women?

https://www.medscape.com/viewarticle/health-gains-exercise-greater-women-2024a10003fv

• Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

III. PCI With or Without Imaging

Intravascular Imaging in PCI: Time for a Guideline Update?

https://www.medscape.com/viewarticle/995677 

• Meta-analysis paper Lancet https://doi.org/10.1016/S0140-6736(23)02454-6
• Imaging uptake paper https://doi.org/10.1093/eurheartj/ehad430

IV. Trial Non-reporting

The Ghost Research Haunting Nordic Medical Trials

https://www.medscape.com/viewarticle/ghost-research-haunting-nordic-medical-trials-2024a10003gz

• Manuscript/preprint https://www.medrxiv.org/content/10.1101/2024.02.04.24301363v1#T10
• Nissen (Rosiglitazone) https://www.nejm.org/doi/10.1056/NEJMoa072761

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An update in trial interpretation, CI, and P-values; percutaneous tricuspid Interventions; and news on HDL and humility in Medicine are the topics John Mandrola, MD, covers in this week’s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Evidence of Absence Is not Absence of Evidence

Feb 09, 2024 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/1000101

• ARCADIA Trial https://jamanetwork.com/journals/jama/fullarticle/2814933
• FOURIER Trial https://www.nejm.org/doi/full/10.1056/nejmoa1615664
• Sample Size Calculator https://clincalc.com/stats/samplesize.aspx

II. Tricuspid Valve Interventions

FDA OKs First Transcatheter Tricuspid Valve Replacement

https://www.medscape.com/viewarticle/fda-oks-first-transcatheter-tricuspid-valve-replacement-2024a10002dq

FDA Panel in Favor of TriClip for Tricuspid Regurgitation

https://www.medscape.com/viewarticle/fda-panel-favor-triclip-tricuspid-regurgitation-2024a100037n

• Cardiothoracic Surgical Trials Network Study https://www.nejm.org/doi/full/10.1056/NEJMoa2115961
• TRILUMINATE https://www.nejm.org/doi/full/10.1056/NEJMoa2300525
• KAUL Tweet on ATTR Cardiomyopathy https://twitter.com/kaulcsmc/status/1753552603534016622?s=20
• APOLLO B trial https://www.nejm.org/doi/full/10.1056/NEJMoa2300757
• Al-Lamee Tweet on Sham Controls https://x.com/rallamee/status/1758236588570562736

III. HDL Cholesterol

• Rationale paper — AEGIS https://doi.org/10.1016/j.ahj.2020.10.052
• Press Release AEGIS II https://www.prnewswire.com/news-releases/csl-announces-top-line-results-from-the-phase-3-aegis-ii-trial-evaluating-the-efficacy-and-safety-of-csl112-apolipoprotein-a-i-human-302059156.html

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Beta-blocker withdrawal in HFpEF, the ARCADIA trial, food as medicine, and bariatric surgery are the topics John Mandrola, MD, discusses in today’s podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. HFpEF and Heart Rate

• PRESERVE HF Substudy https://jamanetwork.com/journals/jamacardiology/fullarticle/2814596
• PRESERVE HF Original https://doi.org/10.1016/j.jacc.2021.08.073

II. ARCADIA trial

• ARCADIA Main Paper: Apixaban vs ASA https://jamanetwork.com/journals/jama/fullarticle/2814933
• KAMEL’s AF and Stroke Paper 10.1161/STROKEAHA.115.012004
• AVERROES Substudy -- 10.1016/S1474-4422(12)70017-0

III. Food as Medicine

• Food-As-Medicine Trial results: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812982
• NPR Story https://www.npr.org/sections/thesalt/2017/05/08/526952657/fresh-food-by-prescription-this-health-care-firm-is-trimming-costs-and-waistline

IV. Bariatric Surgery

Weight Loss Surgery Yields Long-Term BP Control in Obesity

https://www.medscape.com/viewarticle/weight-loss-surgery-yields-long-term-bp-control-obesity-2024a10002le

• Gateway RCT https://doi.org/10.1016/j.jacc.2023.11.032

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