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An editorial discusses the potential of drug-coated balloons (DCBs) as a treatment for in-stent restenosis in coronary artery disease. It highlights the AGENT IDE study, the first U.S. trial evaluating DCBs, which showed superiority over conventional balloons in reducing adverse events. It notes that using noncoated balloons as the control may not reflect current practice.

The association between blood transfusion and mortality among patients with acute coronary syndromes who develop bleeding, anemia or both during their hospital course are determined. It was found that blood transfusion in the setting of acute coronary syndromes is associated with higher mortality and this relationship persists after adjustment for other predictive factors and timing of events.

The Killip classification system can accurately predict which patients with a non-ST-segment heart attack may die within the following year, according to a study of 26,090 patients. Those in Killip class 3 or 4 had higher 30-day and six-month death rates than those in Killip class 1 or 2. The Killip classification is used to indicate a patient's degree of heart failure. Killip 1 or 2 indicates no heart failure or mild heart failure and Killip 3 or 4 indicates moderate to severe heart failure.

A group of cholesterol-lowering drugs called statins do not appear to benefit patients who have had a heart attack or unstable angina. This was the conclusion of a study of 12,365 patients, half of whom began taking statins and half of whom did not. Ninety-day and one-year mortality rates were the same in both groups., Context: The secondary prevention benefit of therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been clearly demonstrated; however, the role of early initiation of statins after acute coronary syndromes (ACSs) is unknown. Objective: To evaluate the association of early statin initiation ([less than or equal to]7 days) after ACS with 90-day and 1-year outcomes. Design: Observational cohort from databases of 2 randomized clinical trials, SYMPHONY and 2nd SYMPHONY. Setting: Nine hundred thirty-one clinical centers in 37 countries. Patients: A total of 12365 ACS patients randomized from August 1997 to August 1999 who were not taking statins prior to the index ACS and who either started statin therapy early (median, 2.0 [interquartile range, 1.0-3.1] days after ACS; n=3952) or survived more than 5 days after ACS and never received statin therapy (n=8413). Main Outcome Measures: Ninety-day incidence of death; death or myocardial infarction (MI); and death, MI, or severe recurrent ischemia; as well as 1-year incidence of death. Results: Ninety-day and 1-year unadjusted mortality comparison suggested early statin benefit (1.2% for early statins vs 2.1% for no statins; hazard ratio [HR], 0.58; 95% confidence interval [CI] 0.42-0.81 for 90-day comparisons and 2.3% for early statins vs 4.4% for no statins; HR, 0.52; 95% CI, 0.40-0.68 for 1-year comparison). However, no benefit was evident for 90-day death or Ml (6.5% vs 6.9%; HR, 0.95; 95% CI, 0.82-1.11) or death, MI, or severe recurrent ischemia (9.2% vs 8.9%; HR, 1.04; 95% CI, 0.92-1.18). After propensity and covariate adjustment, there were no 90-day or 1-year differences between the early-statin group and the no-statin group. The 90-day adjusted HR for death was 1.08 (95% CI, 0.75-1.56); for death or MI, 1.08 (95% CI, 0.91-1.29); and for death, MI, or severe recurrent ischemia, 1.15 (95% CI, 0.99-1.34). One-year mortality-adjusted HR was 0.99 (95% CI, 0.73-1.33). Among 2711 patients with core laboratory lipid analysis, early statin was associated with higher adjusted risk for death o r death or MI at cholesterol levels below treatment guidelines but was more favorable at higher levels. Conclusions: In this study, there was no relationship between early initiation of statin therapy and improved outcomes although our subset analysis suggests that outcomes after early statin initiation may vary with cholesterol levels. Confirmation of early treatment effects of statins on outcomes awaits the results of adequately powered randomized clinical trials.

In-stent restenotic lesions are an important clinical problem and of the numerous modalities used to treat them till date, vascular brachytherapy has been the most effective. Some concerns however about brachytherapy including safety of radiation therapy have led to trials of other therapies and of these drug-eluting stents appear to be the most acceptable.

Heparin is known to reduce ischemic occurrences beyond that of aspirin in acute coronary setting and unfractionated heparin is known to have several limitations and inability to inhibit clot-bound thrombin. Trials show that enoxaparin is a good alternative to unfractionated heparin in regular acute coronary syndrome (ACS) treatment.

The article focuses on the results of the TAILOR-PCI randomized study examining a clinical decision strategy that depends on CYP2C19 genotyping to guide antiplatelet drug assignment following percutaneous coronary interventions. Study subjects received clopidogrel without initial genetic testing while another group of subjects received clopidogrel versus ticagrelor or prasugel. It suggests the use of a personalized medicine approach that involved genotyping for therapeutic interventions.

Paclitaxel-eluting and sirolimnus-eluting cardiovascular stents are tested for effective treatment.

Patients with symptoms of a heart attack who also have increased blood levels of cardiac troponins have a high risk of death and should be treated with angioplasty. Troponins are proteins produced by the heart when it is damaged. However, the tests for troponin can produce different results, and many medical conditions can cause a false-negative or false-positive result.

The authors comment on a Japanese study that examined iterations of shorter-duration dual antiplatelet therapy (DAPT) in patients in Japan who received everolimus-eluting stents by discontinuing aspirin instead of the P2Y12 inhibitor as has commonly been the approach. They compare the findings of the study with those of a similar study in Korea that involved patients who received a current-generation drug-eluting stent. They also discuss the possible impact of the results on clinical practice.

This article focuses on a placebo-controlled phase 3 study of the effectiveness of the drug, pexelizumab, as an adjunct to percutaneous transliminal coronary intervention (PCI) in the treatment of patients with acute ST-elevation myocardial infarction. Patients received either placebo or pexelizumab prior to PCI. The main outcome measures were all-cause mortality up to the 30th day, death up to the 90th day and either death, cardiogenic shock or congestive heart failure through days 30 and 90. This study determined that mortality was low in the subjects studied and the administration of pexelizumab did not affect mortality rate.

Presents an editorial regarding the treatment of ischemic heart disease for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. Description of a study conducted by the Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction investigators; Trial in which patients receiving thrombolytic therapy received a dose of either clopidogrel or placebo; Reference to a study by Sabatine et al. in the September 14, 2005 issue of the journal regarding clopidogrel pretreatment.

Presents a letter to the editor about fractionating heparin.

Importance: Shortened dual antiplatelet therapy followed by potent P2Y12 receptor inhibitor monotherapy reduces bleeding without increasing ischemic events after percutaneous coronary intervention (PCI)., Objective: To explore sex differences and evaluate the association of sex with outcomes among patients treated with ticagrelor monotherapy vs ticagrelor plus aspirin., Design, Setting, and Participants: This was a prespecified secondary analysis of TWILIGHT, an investigator-initiated, placebo-controlled randomized clinical trial conducted at 187 sites across 11 countries. Study participants included patients who underwent successful PCI with drug-eluting stents, were planned for discharge with ticagrelor plus aspirin, and who had at least 1 clinical and at least 1 angiographic feature associated with high risk of ischemic or bleeding events. Data were analyzed from May to July 2020., Interventions: At 3 months after PCI, patients adherent to ticagrelor and aspirin without major adverse event were randomized to either aspirin or placebo for an additional 12 months along with ticagrelor., Main Outcomes and Measures: The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding at 12 months after randomization. The primary ischemic end point was a composite of death, myocardial infarction, or stroke., Results: Of 9006 enrolled patients, 7119 underwent randomization (mean [SD] age, 63.9 [10.2] years; 5421 [76.1%] men). Women were older (mean [SD] age, 65.5 [9.6] years in women vs 63.4 [10.3] years in men) with higher prevalence of chronic kidney disease (347 women [21.2%] vs 764 men [14.7%]). The primary bleeding end point occurred more often in women than men (hazard ratio [HR], 1.32; 95% CI, 1.06-1.64; P = .01). After multivariate adjustment, incremental bleeding risk associated with female sex was no longer significant (adjusted HR, 1.20; 95% CI, 0.95-1.52; P = .12). Ischemic end points were similar between sexes. Ticagrelor plus placebo vs ticagrelor plus aspirin was associated with lower risk of BARC type 2, 3, or 5 bleeding in women (adjusted HR, 0.62; 95% CI, 0.42-0.92; P = .02) and men (adjusted HR, 0.57; 95% CI, 0.44-0.73; P < .001; P for interaction = .69). Ischemic end points were similar between treatment groups in both sexes., Conclusions and Relevance: These findings suggest that the higher bleeding risk in women compared with men was mostly attributable to baseline differences, whereas ischemic events were similar between sexes. In this high-risk PCI population, the benefits of early aspirin withdrawal with continuation of ticagrelor were generally comparable in women and men., Trial Registration: ClinicalTrials.gov Identifier: NCT02270242.