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Journal and News Scan

Source: CTSNet
Author(s): Donald D. Chang, MD PhD

The Southern Thoracic Surgical Association (STSA) is a regional society whose mission is to support members of the cardiothoracic community. Since 1954, STSA has held its annual meeting to promote the scholarly work and networking of its members. This year, Donald D. Chang, MD PhD had the privilege of attending the 68th Annual Meeting as a James W. Brooks scholar, named in honor of the Society’s 23rd President for his lifelong support and contribution to the society. Here he gives his account of his experiecs at the event.

Source: The Annals of Thoracic Surgery
Author(s): Joseph F. Sabik III, MD, Faisal G. Bakaeen, MD, Marc Ruel, MD, MPH, Marc R. Moon, MD, S. Christopher Malaisrie, MD, John H. Calhoon, MD, Leonard N. Girardi, MD, Robert Guyton, MD

The American Association for Thoracic Surgery and Society of Thoracic Surgeons share their reasoning for not endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines. To read these guidelines, click here.

Source: European Association for Cardio-Thoracic Surgery
Author(s): Friedhelm Beyersdorf, Rafa Sádaba, Milan Milojevic, Patrick Myers

This is a letter from EACTS about the new ACC/AHA/SCAI guidelines. To ready these guidelines, click here.

Source: Journal of the American Heart Association
Author(s): Simeon Isezuo, Mahmoud Umar San, Abdullahi Talle, et al.

The rising burden of CAD in low- and middle-income countries like Nigeria is a result of the epidemiological transition from communicable to non- communicable diseases. The system of care for acute coronary syndrome (ACS) is evolving and constrained by a lack of prehospital emergency services, prolonged intervention times, and low patient eligibility and infrastructural capacity for reperfusion. Management guidelines that are based on best practices in resource-endowed nations may not be implementable, with the consequence of  frequent major adverse cardiac events and high mortality.

This observational multicentered national registry enrolled 1072 Nigerians with ACS to evaluate incidence, intervention times, reperfusion rates, and 1 year mortality. Recommendations are considered for preventative strategies and  infrastructure-appropriate management guidelines.

Source: Journal of American College of Cardiology
Author(s): Jennifer S. Lawton, Jacqueline E. Tamis-Holland, Sripal Bangalore, Eric R. Bates, Theresa M. Beckie, James M. Bischoff, John A. Bittl, Mauricio G. Cohen, J. Michael DiMaio, Creighton W. Don, Stephen E. Fremes, Mario F. Gaudino, Zachary D. Goldberger, Michael C. Grant, Jang B. Jaswal, Paul A. Kurlansky, Roxana Mehran, Thomas S. Metkus, Lorraine C. Nnacheta, Sunil V. Rao, Frank W. Sellke, Garima Sharma, Celina M. Yong, and Brittany A. Zwischenberger

Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with this disease. The 2021 Coronary Artery Revascularization Guideline, released on December 9 by the American College of Cardiology, and American Heart Association, and the Society for Cardiovascular Angiography and Interventions, provides recommendations based on contemporary evidence for the treatment of these patients.

Source: Latin-American Association of Cardiac and Endovascular Surgery
Author(s): Dr. Victor Dayan, Dr. Rui M. S. Almeida, Dr. Javier Ferrari, Dr. Alejandro Escobar, Dr. Jose Antonio Heredia, Dr. Eduard Quintana, Dr. Mateo Marin-Cuartas

This public statement from the Latin-American Association of Cardiac and Endovascular Surgery (LACES) identifies what it feels are evidence gaps and contradictions in the recommendations that will impact the treatment of millions of patients worldwide.

Source: TCTMD
Author(s): Michael O'Riordan

Despite participation in the three-year writing process, the American Association for Thoracic Surgery (AATS) and the Society of Thoracic Surgeons (STS) have ultimately decided not to endorse the recently released ACC/AHA/SCAI Coronary Revascularization Guidelines. “The Society applauds the efforts to develop recommendations in this area, but disagrees with the interpretation of the scientific evidence,” STS First Vice President John Calhoon, MD told TCTMD in an emailed statement.

Source: American College of Cardiology
Author(s): Lawton JS, Tamis-Holland JE, Bangalore S, et al.

In early December, the American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions released a new guideline for the revascularization of coronary artery disease, which are intended to replace or retire six existing guidelines. This article summarizes ten key perspectives from the new guideline

Source: Heart
Author(s): Maaz Syed, Zaid Iskander, Alexander Fletcher, Samuel Debono, Marc Dweck, Jeffrey T J Huang, Calvin Chin, David Newby, Anna Maria Choy

Interesting early work  on the prognostic value in aortic disease of the cross-link component in the elastin.

Source: Journal of the American College of Cardiology
Author(s): Jennifer S. Lawton, Jacqueline E. Tamis-Holland, Sripal Bangalore, Eric R. Bates, Theresa M. Beckie, James M. Bischoff, John A. Bittl, Mauricio G. Cohen, Michael DiMaio, Creighton W. Don, Stephen E. Fremes, Mario F. Gaudino, Zachary D. Goldberger, Michael C. Grant, Jang B. Jaswal, Paul A. Kurlansky, Roxana Mehran, Thomas S. Metkus Jr., Lorraine C. Nnacheta, Sunil V. Rao,

On December 9, the  American Heart Association (AHA) and American College of Cardiology (ACC) jointly released a clinical practice guideline for coronary artery revascularization in patients with coronary artery disease.  The top ten take-home messages are:

1. Treatment decisions regarding coronary revascularization in patients with coronary artery disease should be based on clinical indications, regardless of sex, race, or ethnicity.

2. In patients being considered for coronary revascularization for whom the optimal treatment strategy is unclear, a multidisciplinary Heart Team approach is recommended. 

3. For patients with significant left main disease, surgical revascularization is indicated to improve survival relative to that likely to be achieved with medical therapy. 

4. Updated evidence from contemporary trials supplement older evidence with regard to mortality benefit of revascularization in patients with stable ischemic heart disease, normal left ventricular ejection fraction, and triple-vessel coronary artery disease. Surgical revascularization may be reasonable to improve survival. A survival benefit with percutaneous revascularization is uncertain. 

5. The use of a radial artery as a surgical revascularization conduit is preferred versus the use of a saphenous vein conduit to bypass the second most important target vessel with significant stenosis after the left anterior descending coronary artery. 

6. Radial artery access is recommended in patients undergoing percutaneous intervention who have acute coronary syndrome or stable ischemic heart disease, to reduce bleeding and vascular complications compared with a femoral approach.

7. A short duration of dual antiplatelet therapy after percutaneous revascularization in patients with stable ischemic heart disease is reasonable to reduce the risk of bleeding events. After consideration of recurrent ischemia and bleeding risks, select patients may safely transition to P2Y12 inhibitor monotherapy and stop aspirin after 1 to 3 months of dual antiplatelet therapy (Previous recommendations called for 6 or 12 months of DAPT)

8. Staged percutaneous intervention (while in hospital or after discharge) of a significantly stenosed nonculprit artery in patients presenting with an ST-segment–elevation myocardial infarction is recommended in select patients to improve outcomes. 

9. Revascularization decisions in patients with diabetes and multivessel coronary artery disease are optimized by the use of a Heart Team approach.  

10. Treatment decisions for patients undergoing surgical revascularization of coronary artery disease should include the calculation of a patient’s surgical risk with the Society of Thoracic Surgeons score. The usefulness of the SYNTAX score calculation in treatment decisions is less clear.

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