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Dear Readers,
This has been another extraordinary year for breakthroughs in cardiology, and I am pleased to provide you with our top stories of the year, chosen by our board of editors.
Leading the way this year is the SPRINT trial, which may ultimately change the way we think about blood pressure targets. For now, the study seems less of a mandate for lower targets than information about the trade-offs involved with more treatment, which, for many patients, will likely seem worth the risks. A report questioning current practices was a randomized trial of patients with atrial fibrillation who were anticoagulated before elective surgery; the results revealed that bridging anticoagulation provided no benefit.
Other studies validated current practices. For example, the IMPROVE-IT trial finally showed that ezetimibe, when added to statin therapy in patients with low LDL-cholesterol levels, could improve outcomes. Aggressive risk factor reduction in patients with atrial fibrillation who underwent ablation produced improvements in weight, blood pressure, blood sugar, and sleep apnea. Complete revascularization for ST-segment elevation myocardial infarction seemed better than a focus on the culprit artery, validating what many interventionalists had long believed despite earlier negative studies. And a liberal or a restricted policy for transfusions after cardiac surgery did not seem to matter, vindicating whichever strategy people are currently using. Prolonged dual platelet inhibition was shown beneficial 3 years after the event.
Some studies on innovative devices and medications held promise for the future. An observational study showed that the leadless pacemaker has promise, although more data are needed. The PCSK-9 studies received a lot of notice, and the drugs were approved. Meanwhile, perhaps next year, we may have a study that tells us whether any of these drugs actually improves clinical outcomes. Regarding a device still under FDA review, left atrial appendage occlusion maintained its benefit in extended follow-up of the PROTECT-AF participants.
We'd like to hear what articles you thought were most important last year. Please let us know by adding a reader comment below. Thanks very much for your continued readership of NEJM Journal Watch Cardiology, and our best wishes for 2016.
Our Cardiology Top Stories of 2015 are:
SPRINT: A Trial of Intensive Blood Pressure Lowering
Perioperative Anticoagulation in Atrial Fibrillation: A Bridge to Nowhere
Some Improvement in Post-ACS Outcomes with Adjunctive Ezetimibe
Aggressive Risk Factor Reduction Benefits AF Patients After Ablation
Randomized Trial of Complete vs. Culprit-Only PCI in STEMI
What Is the Optimal Transfusion Threshold After Cardiac Surgery?
Prolonged Dual Platelet Inhibition in Patients with Prior MI
Leadless Pacemaker Continues to Impress, But Is It Ready for Prime Time?