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Sep 7, 2018

Kardsfest

The story

Munich gets plenty of headlines as the calendar turns toward October, but this week cardiology stars. Here are our favorites from the European Society of Cardiology annual meeting. 

Picture perfect

It helps to get the diagnosis right upfront. Or at least so say 5-year outcomes from the SCOT-HEART trial of 4,000 patients who reported to cardiology clinic with chest pain. Those assessed with initial coronary CT angiogram (CTA) had a 40% lower rate of death from CV disease or myocardial infarction (MI) compared to standard care (in this case exercise EKG), which researchers think is due to prompt recognition and medical management of coronary obstruction. And while the trial's 20-month outcomes showed that CTA increased invasive testing, 5-year outcomes found no difference in trips to the cath lab between groups.
NEJM

One at a time

The buzz on 30-day outcomes from 2017’s CULPRIT-SHOCK was that patients with acute MI, cardiogenic shock, and multi-vessel coronary artery disease had lower mortality with culprit lesion-only PCI instead of immediate multi-vessel PCI. Outcomes at 1 year found that the survival difference between groups narrowed due to a higher event rate in the culprit-lesion only group. So while patients in shock may not tolerate multi-vessel PCI, they remain at high-risk for future events. Since the 30-day results, guideline agencies have withdrawn recommendations for multi-vessel PCI in this patient group.
NEJM

By mouth or vein

IV antibiotics are tough on patients and your discharge plans. POET randomized 400 patients with left-sided endocarditis from 4 common bugs to oral antibiotics or standard IV antibiotics. All patients were in stable condition after optimal initial therapy, and on average the patients in the PO group began treatment at day 17. There was no difference in outcomes between groups, meaning PO antibiotics are a safe choice here.  
NEJM

Say it on rounds

When your work outfit is either scrubs or pajamas

It can be hard to tell. The same applies to differentiating sepsis from noninfectious inflammation. An analysis of biomarkers in 5 Italian EDs found that the combination of procalcitonin and soluble phospholipase A2 – an enzyme involved in the production of free fatty acids – ruled out septic shock with a negative predictive value of 100% in a validation cohort of 160 patients with sepsis-like symptoms. The tests could be used to help better screen the 20% of ED patients treated for sepsis when not actually infected. 
Crit Care Med

When you'll drink any kind of coffee, as long as it's free

Right on. A look at self-reported coffee-drinking data from the 500,000 participants in the UK Biobank is the latest study to show an inverse relationship between coffee consumption and mortality. The benefit held for different coffee types including instant, ground, or decaf and even for people who drank more than 8 cups per day. While the mechanism behind coffee's health benefits is unclear, genes related to coffee metabolism did not play a role in this analysis.
JAMA Int Med

Brush up

Alcohol meds

Around 6% of the US population carries a diagnosis of Alcohol Use Disorder (AUD), but only 9% of eligible patients have ever been prescribed a medication to curb use. Together with psychosocial therapy, pharmacotherapy can decrease cravings. Four drugs are currently FDA-approved: disulfram, oral and long-acting injectible naltrexone, and acamprosate (see table for indications and efficacy). The meds do no require abstinence prior to initiation.

Get meta

With oral naltrexone and alcohol abuse. An analysis of 9,000 patients with AUD in 53 studies found a decrease of 5% in relapse to any drinking and a 9% reduction in binge drinking attributed to naltrexone. While total abstinence is the goal, reductions in use, especially in binge drinking, have been shown to improve long-term health outcomes. The results have made naltrexone a popular pick for first-line therapy in AUD. 

What your physics friends are talking about

A JAMA report found evidence of strange cognitive problems among a group of US government personnel in Havana, Cuba in March. Now experts think the attacks are linked to weaponized microwave radiation

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