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Cardiology Top Stories of 2012

A perspective on the most important research in the field from the past year

Dear Readers,

We are pleased to present our annual Journal Watch Cardiology Top Stories list for 2012. Our editors voted on the stories published during the past year that they believe to be most important to you and your practices.

In the spirit of "less is more," several major studies this year failed to show that new drugs or fancy devices produce benefits for patients. We learned that intra-aortic balloon counterpulsation therapy in patients with acute myocardial infarction (MI) and shock does not improve survival. We discovered that patent foramen ovale (PFO) closure in patients with cryptogenic stroke was not superior to medical therapy, and that most recurrent events were unrelated to the PFO. Radiofrequency ablation was not better than medical therapy in patients with paroxysmal atrial fibrillation (AF). Vorapaxar, a highly touted experimental drug, did reduce ischemic events in patients with vascular disease but markedly increased bleeding and had no discernible net clinical benefit. Warfarin was not better than aspirin in patients with heart failure and systolic dysfunction without AF. Platelet-function testing to guide therapy in patients undergoing stenting did not improve their outcomes. An array of fancy lipid biomarkers failed to add to the predictive power of traditional lipid measures. There are a lot of potential cost savings here.

Two other important studies compared interventions and declared a clear winner. The FREEDOM study showed that bypass surgery is better than percutaneous coronary intervention (PCI) for reducing rates of death and MI in patients with diabetes and multivessel coronary artery disease, although the risk for stroke — while low overall — was higher in the surgery arm than in the PCI arm.

The big winner was probably transcatheter aortic-valve replacement (TAVR). In inoperable patients, TAVR was associated with remarkable reductions in mortality compared with medical therapy.

Finally, we were told that if you look with cardiac magnetic resonance, unrecognized acute MI is fairly common and is associated with a slightly increased risk for events. Still, we do not know if that information will help patients achieve better outcomes.

Please let us know what you think by adding a Reader Remark or by sending us an e-mail at jwcard@mms.org.

Diabetes plus Multivessel Coronary Artery Disease: CABG or PCI?

No Mortality Reduction with IABP in Acute MI Patients with Shock

Transcatheter Aortic-Valve Replacement: A Lasting Option for Selected Patients

Warfarin Ineffective for HF Without Atrial Fibrillation

No Apparent Benefit from PFO Closure After Cryptogenic Stroke

Platelet-Function Testing Has No Benefit in Coronary Stenting

Radiofrequency Ablation and Antiarrhythmic Drugs Fight to a Tie

Vorapaxar: Are Small Secondary-Prevention Gains Worth the Bleeding Risk?

Cardiac Magnetic Resonance Reveals High Prevalence of Unrecognized MI in Older Adults

New Lipid Biomarkers of Little Use in Predicting Cardiovascular Risk

Best wishes for 2013,

— Harlan M. Krumholz, MD, SM, Journal Watch Cardiology Editor-in-Chief

Published in Journal Watch Cardiology December 26, 2012

Reader Remarks:

Review and add to remarks on this article

• Thank you!
  HJ Woodward, 25 Jan 2013 11:01 AM EST
  Specialty: Inactive (Retired)
  Thoroughly enjoy the discourse, and thank you to Journal Watch for allowing interested lay persons behind the scenes in the... [more]
• Top Stories of 2012
  Michael Yoong, 28 Jan 2013 11:50 AM EST
  Specialty: Family Medicine
  A Magnificant summary of significant developments in 2012. I enjoyed reading it.
• Top Stories of 2012
  Bryce I. Morrice, MD, FACC, Licking Memorial Hospital, 11 Jun 2013 10:52 AM EST
  Specialty: Cardiovascular Disease
  This was very useful toward my research for a talk I will be giving to my hospitals medical staff.

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