- N Engl J Med 2022; 387:840-841
In contemporary clinical practice, interventional cardiologists use both fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) to guide percutaneous coronary intervention (PCI) for intermediate coronary stenosis (i.e., a narrowing of the coronary-artery lumen by 40 to 70%). FFR, a physiological test, is used to evaluate the ischemic potential of a...
- N Engl J Med 2022; 387:779-789
In a randomized trial of fractional flow reserve versus IVUS to guide PCI, the use of FFR resulted in fewer coronary interventions and was noninferior to IVUS with respect to clinical outcomes at 2 years.
- Original ArticleAug 28, 202210.1056/NEJMoa2208335
In a randomized trial involving patients who had undergone percutaneous coronary intervention, routine functional testing did not improve clinical outcomes at 2 years.
- EditorialAug 28, 202210.1056/NEJMe2210021
More than 100 years ago, Einthoven reported the presence of ST-segment changes on electrocardiography in a patient during exercise.1 His discovery led to the development of the modern-day stress test. In patients with known coronary artery disease, the stress test is useful in assessing residual ischemia after an...
- EditorialAug 27, 202210.1056/NEJMe2210183
Ischemic cardiomyopathy represents the pathophysiological convergence of two growing clinical problems: atherosclerotic coronary artery disease and congestive heart failure. When a patient presents with congestive heart failure, it is incumbent on clinicians to undertake an etiologic workup that includes evaluation for a diagnosis of coronary artery disease1 ; simply...
- Original ArticleAug 27, 202210.1056/NEJMoa2206606
In a randomized trial involving patients with a low LVEF and viable myocardium who received optimal medical therapy, PCI did not lead to a lower incidence of death or hospitalization for heart failure.
- EditorialAug 26, 202210.1056/NEJMe2210020
Next year marks the 20th anniversary of the first appearance of the polypill in the medical literature. Wald and Law coined the term to denote a fixed-dose combination of medications for preventing cardiovascular disease.1 They suggested that administering a polypill to all adults 55 years of age or...
- Original ArticleAug 26, 202210.1056/NEJMoa2208275
Among patients with recent MI, therapy with a polypill containing aspirin, ramipril, and atorvastatin led to a lower incidence of major adverse cardiovascular events at a median of 3 years than usual care.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1659-1660
Correctly interpreting the cause of chest pain is a crucial diagnostic skill that is essential for effective medical practice. Before the development of coronary angioplasty and stenting, the great majority of patients with stable angina (typical or atypical) were treated medically. Currently, patients with stable angina often undergo early invasive...
- N Engl J Med 2022; 386:1591-1602
In this multicenter trial, 3561 patients with stable chest pain at intermediate risk for obstructive coronary artery disease were randomly assigned to undergo CT or invasive coronary angiography. Over 3.5 years of follow-up, there was no significant between-group difference in the risk of major adverse cardiovascular events. Major procedure-related complications...
- N Engl J Med 2022; 386:890-891
Perioperative myocardial infarction is an important complication after cardiac surgery that leads to excess perioperative mortality. Perioperative myocardial infarction may be caused by inadequately treated preoperative ischemia, insufficient interoperative myocardial protection, or untoward surgical events (e.g., incomplete revascularization, graft failure, or embolization). Accurate early diagnosis of perioperative myocardial infarction may...
- N Engl J Med 2022; 386:827-836
A prospective cohort study of 13,862 patients showed that among those who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold high-sensitivity cardiac troponin I level (within 1 day after surgery) associated with an adjusted hazard ratio for death within 30 days of more than 1.00 was...
- N Engl J Med 2022; 386:185-187
The management of coronary artery disease has evolved through spirited debates, and among the most fraught has been the debate about whether coronary-artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is most appropriate for patients with multivessel coronary disease. At each milestone in percutaneous technology, PCI has been tested...
- N Engl J Med 2022; 386:128-137
In this trial involving patients with three-vessel coronary artery disease, PCI guided by assessment of fractional flow reserve was not noninferior to CABG with respect to the composite end point of death, myocardial infarction, stroke, or repeat revascularization at 1 year. The incidence of this composite end point was higher...
- N Engl J Med 2021; 385:2544-2553
In this randomized trial involving patients with out-of-hospital cardiac arrest without ST-segment elevation on postresuscitation electrocardiography, no benefit was found for immediate cardiac catherization as compared with delayed or selective catherization.
- N Engl J Med 2021; 385:2325-2335
This trial compared the oral HIF-PHI daprodustat with conventional erythropoiesis-stimulating agents for the treatment of anemia in patients with chronic kidney disease receiving dialysis. Daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes.
- N Engl J Med 2021; 385:2313-2324
This randomized trial compared daprodustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, with darbepoetin alfa for the treatment of anemia in patients with chronic kidney disease who were not undergoing dialysis. Daprodustat was noninferior to darbepoetin alfa with respect to the change in hemoglobin level and cardiovascular outcomes.
- N Engl J Med 2021; 385:1906-1907
Fight-or-flight systems evolved to support humans through acute physiological threats that are now less common than chronic cardiovascular stress. Progressive activation of the sympathetic nervous system and the renin–angiotensin–aldosterone system (RAAS) contributes to chronic heart failure, including that which occurs after acute myocardial infarction. Pharmacologic inhibition of the RAAS improves...
- N Engl J Med 2021; 385:1881-1892
Environmental pollution is a cardiovascular risk factor. The Global Burden of Disease study estimated that pollution caused 9 million deaths in 2019, of which more than 60% were due to cardiovascular disease. Transitioning to renewable energy sources may reduce such deaths. This review summarizes the current evidence, and an interactive...