TCTMD’s Top 10 Most Popular Stories for April 2016


TAVR in moderate-risk patients, comparisons of the novel oral anticoagulants, and our three-part series on what works and what doesn’t with the Heart Team were among our most popular stories for April. Half of our top-ten list stems from the American College of Cardiology 2016 Scientific Sessions—including our coverage of HOPE-3—but readers also wanted to learn more about the new USPSTF guidelines for aspirin in primary prevention, updated LDL cholesterol-lowering guidelines, and the public response to the ICMJE’s “data-sharing” proposal.

In case you missed them, here are the top stories on TCTMD for April 2016. 

SAPIEN 3 Superior to Surgery Among Intermediate-Risk Patients in Observational Trial

The use of a noncontemporary control group will draw “appropriate criticism,” experts said, but it does not detract from the strength of the results, which show that the latest iteration of the FDA-approved balloon-expandable transcatheter aortic valve is superior to surgery among intermediate-risk patients in a matched-registry analysis.

Real-World Study Largely Confirms Effects of Apixaban, Rivaroxaban for A-fib

Care must be taken when interpreting results derived from claims data, but a new study showing that both rivaroxaban and apixaban carry lower risks of intracranial hemorrhage versus warfarin when used in everyday practice for patients with nonvalvular A-fib is reassuring, experts say.

HOPE-3: Reducing LDL Cholesterol Improves Outcomes in Intermediate-Risk Patients, but BP-Lowering Does Not

Investigators say the results don’t support blanket lipid- and blood pressure-lowering in all patients at intermediate risk, but they maintain that certain individuals, particularly those with higher baseline systolic blood pressure, could benefit from the simple, low-cost combination of statin therapy and two antihypertensive medications.  

USPSTF Tightens Up Primary-Prevention Recommendations, Saying Aspirin Should Be Used Only in High-Risk Individuals

Capping a decade of debate and confusion over the relative benefits and risks of aspirin in healthy adults, the US Preventive Services Task Force is tightening up the use of low-dose aspirin by limiting its use to high-risk individuals between the ages of 50 to 69 years—as opposed to a much broader patient population in the 2009 recommendations.

Comparing the Novel Oral Anticoagulants: Effectiveness Similar, but Apixaban May Come With Less Bleeding

A study of administrative claims suggests that dabigatran, rivaroxaban, and apixaban perform similarly for preventing stroke or systemic embolism in patients with nonvalvular A-fib, although apixaban seemed to carry a lower major bleeding risk compared with the other two drugs.

Asymptomatic Aortic Stenosis: The Next Frontier for TAVR?

As the potential pool of patients with symptomatic aortic stenosis who may benefit from TAVR expands to lower-risk candidates, some researchers believe the time has come to study the benefit of intervening early in those with asymptomatic disease, compared with current recommendations for ‘watchful waiting.’ 

New-Generation Watchman FLX Device Pulled From European Shelves Over Embolism Concerns

Reports of device embolization during the limited market rollout of the next-generation Watchman FLX left atrial appendage closure device in Europe have caused manufacturer Boston Scientific to halt sales and pull the product from doctors’ shelves, the company announced during an analysts call in early April.

ACC Updates LDL Cholesterol-Lowering Recommendations, Making Room for Ezetimibe and PCSK9 Inhibitors

The American College of Cardiology has updated their recommendations for the management of elevated LDL cholesterol levels in high-risk patients, specifically addressing the use of nonstatin therapies, such as PCSK9 inhibitors and ezetimibe, in patients unable to achieve sufficient LDL cholesterol-lowering.

TAVR With Sapien XT Noninferior to Surgery in Intermediate-Risk Patients, With a Win for Transfemoral

Transcatheter aortic valve replacement using a second-generation balloon-expandable device is at least as good as surgery in intermediate-risk patients with severe symptomatic aortic stenosis. What’s more, for those who can be treated via a transfemoral approach, TAVR may be the winning strategy. 

ICMJE Gets an Earful on Its Data-Sharing Proposal for Clinical Trials

The open public comment period closed last week on the International Committee of Medical Journal Editors’ proposal for sharing clinical trial data with a whopping 319 comments that read in part like a Who’s Who in Medicine and, very occasionally, like a lot of sardonic eye-rolling.

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Here’s our three-part series on the Heart Team: What Works, What Doesn’t, and What the Future May Hold

Where Theory Meets Practice: Getting to the Heart of the Heart Team

We Asked, You Answered: The Heart Team by the Numbers

From Chaos to Consistency: How One Michigan Hospital Built a Heart Team That Works

Last but not least, if you don’t have time to read the top news, consider listening to it instead. Our new Heart Sounds podcast recaps our biggest stories each month. You can stream Heart Sounds along with two other podcasts from our Pulse of Cardiology network.  

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