The DEDICATE trial of TAVR vs SAVR, more on renal denervation, inclisiran, and marketing disguised as science 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. TAVR vs SAVR

TAVI Comparable With SAVR in Lower-Risk Aortic Stenosis

https://www.medscape.com/viewarticle/tavi-comparable-savr-lower-risk-aortic-stenosis-2024a100074o?form=fpf

• DEDICATE https://www.nejm.org/doi/full/10.1056/NEJMoa2400685
• Partner 3 https://www.nejm.org/doi/full/10.1056/NEJMoa1814052
• Evolut Low Risk https://www.nejm.org/doi/full/10.1056/NEJMoa1816885
• Barili meta-analysis https://doi.org/10.1093/ejcts/ezab516

II. Renal Denervation

Alcohol-Mediated Renal Denervation Promising in Hypertension

https://www.medscape.com/viewarticle/alcohol-mediated-renal-denervation-promising-hypertension-2024a10007eg

• TARGET 1 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069291

III. Inclisiran

Earlier Inclisiran Gives Better Long-Term LDL Reductions

https://www.medscape.com/viewarticle/earlier-inclisiran-gives-better-long-term-ldl-reductions-2024a10007d6

• VICTORIAN INITIATE Trial https://www.jacc.org/doi/10.1016/j.jacc.2024.03.382

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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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