Chirag Bavishi

GIM/FP/GP:[Formula: see text] Cardiology:[Formula: see text].

Transcatheter left atrial appendage closure has emerged as a non-pharmacological alternative to long-term anticoagulation for stroke prevention in appropriately selected patients with AF. In this concise review article, the Food and Drug Administration-approved and some other left atrial appendage closure devices that are under investigation are discussed. Currently, Watchman Flx and Amplatzer Amulet are the only two devices that have been approved for commercial use by the Food and Drug Administration. A brief overview of device designs, clinical data on efficacy and safety, major limitations of left atrial appendage closure devices, and perspectives on future direction are provided. The current generation of devices is effective; however, efforts should continue on innovations and refinement of device technology.

Introduction: The American Heart Association/American College of Cardiology guidelines on dual antiplatelet therapy (DAPT) recommend at least 12 months of a P2Y12 inhibitor and low dose aspirin in patients with an acute coronary syndrome (ACS) treated with a stent. Since that recommendation, several randomized controlled trials (RCTs) have studied an abbreviated duration of DAPT in ACS. Therefore, we sought to perform a meta‐analysis of RCTs comparing 3‐ versus 12‐month DAPT in patients presenting with ACS undergoing percutaneous coronary intervention (PCI).Methods: PubMed, Embase, and Cochrane Central databases were searched until July 31, 2022, for RCTs comparing 3‐ versus 12‐month DAPT in patients with ACS undergoing PCI. Outcomes assessed were major adverse cardiovascular events (MACE), cardiovascular mortality, all‐cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding. A random‐effects model was used to calculate pooled relative risk (RR) and 95% confidence intervals (CI).Results: We included 5 trials comprising 16,781 patients with an ACS that underwent PCI. There was no significant difference in MACE (RR: 0.92; 95% CI: 0.76–1.11), cardiovascular mortality (RR: 1.26; 95% CI: 0.38–4.17), or all‐cause mortality (RR: 0.92; 95% CI: 0.48–1.77) between the 2 groups. In addition, there was no difference in rates of MI (RR: 0.98; 95% CI: 0.74–1.30), or ST (RR: 1.30; 95% CI: 0.55–3.05) between 3‐ and 12‐month DAPT. However, compared with 12‐month DAPT, 3‐month DAPT significantly reduced risk of major bleeding (RR: 0.53; 95% CI: 0.43–0.64).Conclusions: In patients with ACS undergoing PCI, 3‐month DAPT reduced risk of bleeding without evidence of harm.

This commentary refers to ‘On cerebrotoxicity of antihypertensive therapy and risk factor cosmetics’, by F.H. Messerli et al., doi:10.1093/eurheartj/ehaa971 and the discussion piece ‘How to identify which patients should not have a systolic blood pressure target of doi:10.1093/eurheartj/ehab552.

Background To date, only dexamethasone has been shown to reduce mortality in COVID-19 patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remains conflicting. Methods Electronic databases such as MEDLINE, EMBASE and Cochrane central were searched from March 1, 2020, until February 28th, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality at 28 days, mechanical ventilation, and time to discharge. Results Eight studies (with 6,311 patients) were included in the analysis. In total, 3,267 patients received tocilizumab, and 3,044 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality at 28 days (RR 0.90, 95% CI 0.83-0.97, p=0.009) and progression to mechanical ventilation (RR 0.79, 95% CI 0.70-0.90, p=0.0002) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.18, 95% CI 1.05-1.34, p=0.007). Conclusions Tocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients.

Transcatheter pulmonary valve replacement: an option for some but not for all