The Cold Truth of COLCOT

Dr. Toby Trujillo discusses the COLCOT trial.

Episode Breakdown:

0:00-0:40: Intro

0:41-1:30: Introduction of Dr. Toby Trujillo

1:31-3:56: COLCOT overview

3:57-4:50: Toby’s initial thoughts

4:51-6:08: Anti-inflammatory agents

6:09-7:09: Pneumonia?

7:10-8:29: Baseline Management of Patients

8:30-10:15: Who is the niche colchicine patient?

10:16-12:05: Drug burden and cost

12:06-13:03: Follow-up period

13:04-13:59: Final thoughts

14:00-14:44: Closing

References:

  • COLCOT Trial: Tardif J, Kouz S, Water DD, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med 2019;381:2497-505.
  • CANTOS Trial: Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017;377:1119-31.
  • CIRT Trial: Ridker PM, Everett BM, Pradhan A, et al. Low-dose methotrexate for the prevention of atherosclerotic events. N Engl J Med 2019;380:752-62.
  • LoDoCo Trial: Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol 2013;61:404-10.

Return of the Lytics with Dr. Danielle Blais

Tune in as Dr. Danielle Blais discusses everything lytics.

References:

  • https://www.acc.org/latest-in-cardiology/articles/2020/03/18/15/07/poll-covid-19-and-interventional-cardiology
  • Welt FGP, Shah PB, Aronow HD, et al. Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From American College of Cardiology’s (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI).  J Am Coll Cardiol  2020; DOI: 10.1016/j.jacc.2020.03.021
  • ISIS-2 Collaborative Group. Randomised Trial of Intravenous Streptokinase, Oral Aspirin, Both, or Neither among 17187 Cases of Suspected Acute Myocardial Infarction. The Lancet. 1988; 332(8607):349-360.
  • O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force of Practice Guidelines. J Am Coll Cardiol 2013; 61(4): DOI: 10.1016/j.jacc.2012.11.019
  • Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
  • Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation (CLARITY). N Engl J Med 2005; 352:1179-1189
  • Chen ZMJiang LXChen YP, et al  Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial (COMMIT). Lancet. 2005 Nov 5;366(9497):1607-21.
  • Berwanger O, Lopes RD, Moia DF, et al. Ticagrelor Versus Clopidogrel in Patients with STEMI Treated with Fibrinolytic Therapy: TREAT Trial. J Am Coll Cardiol 2019;73:2819-28.
  • Wiviott ST, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes (TRITON). The N Engl J Med. 2007; 357(20):2001-2015. 
  • Antman EM, Morrow DA, McCabe CH, Murphy SA, Ruda M, Sadowski Z, Budaj A, López-Sendón JL, Guneri S, Jiang F, White HD, Fox KAA, Braunwald E, for the ExTRACT-TIMI 25 Investigators. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006;354(15):1477-1488
  • Guillermin A, Yan DJ, Perrier A, et al.  Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: a systematic review and meta analysis of randomized trials. Arch Med Sci 2016;12:1181-1187.

Chlorthalidone vs. Hydrochlorothiazide: The Debate That Never Ends

Dr. Karen McConnell discusses a recent trial comparing chlorthalidone vs. hydrochlorothiazide for the treatment of hypertension.

0:00-0:40: Intro
0:41-1:51: Introduction of Dr. Karen McConnell
1:52-6:19: Trial overview
6:20-9:15: Karen’s Overall Thoughts
9:16-10:13: Trial Design 
10:14-10:54: Side Effect Differences
10:55-12:36: Choosing Between Chlorthalidone and HCTZ
12:37-14:03: Final Thoughts
14:04-14:49: Closing

References:

  • Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Intern Med 2020. doi: 0.1001/jamainternmed.2019.7454.
  • Lederle FA, Cushman WC, Ferguson RE, Brophy MT, Fiore LD. Chlorthalidone Versus hydrochlorothiazide: a new kind of Veterans Affairs cooperative study. Ann Intern Med 2016;165(9):663-4. doi: 10.7326/M16-1208.
  • Veterans Affairs Diuretic Comparison Project: https://clinicaltrials.gov/ct2/show/NCT02185417?cond=Diuretic+Comparison+Project&draw=2&rank=1
  • ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor of calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Tretment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981-97.

Crushing ISCHEMIA with Dr. Barbara Wiggins

Dr. Barbara Wiggins joins the CardioScripts team to talk about the ISCHEMIA trial.

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Barbara Wiggins
1:23-5:26: Introduction of ISCHEMIA
5:27-6:37: Barbara’s Overall Thoughts
6:38-7:33: What does the ISCHEMIA trial add to COURAGE?
7:34-8:27: Patient Baseline Medication Regimens
8:28-10:42: ISCHEMIA Questions
10:43-11:51: ISCHEMIA Implications for Pharmacy Practice
11:52-14:03: Barbara’s Final Thoughts
14:04-14:48: Closing

References:

  • ISCHEMIA Trial: The ISCHEMIA Trial Home (https://www.ischemiatrial.org/)
  • COURAGE Trial: Boden WE, O’Rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med 2007;356:1503-16.

PIONEERing HF Care with Dr. Van Tassell

Dr. Ben Van Tassell discusses sacubatril-valsartan and the PIONEER-HF trial.

0:00-0:40: Intro
0:41-1:14: Introduction of Dr. Ben Van Tassell
1:15-4:00: Introduction of PIONEER-HF
4:01-5:22: Ben’s Initial Thoughts
5:23-6:40: Sacubatril-valsartan right out of the gate?
6:41-7:50: Thoughts on open-label expansion trial
7:51-11:12: Role of NT-proBNP as a surrogate endpoint
11:13-14:17: Cost considerations with sacubitril-valsartan
14:18-15:33: Patient follow-up in a real-world setting
15:34-16:13: Closing

References:

  • PIONEER-HF: Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med 2019;380:539-48.
  • PIONEER-HF open-label expansion: DeVore AD, Braunwald E, Morrow DA, et al. Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial. JAMA Cardiol 2020;5(2):202-207.
  • PARADIGM-HF: McMurray JJ, Packer M, Desai AS, et al. Angiotensin-Neprilysisn Inhibition versus Enalapril in Heart Failure. N Engl J Med 2014;371:993-1004.
  • Ibrahim NE and Januzzi JL Jr. Established and Emerging Roles of Biomarkers in Heart Failure. Circ Res 2018;123(5):614-29.

Spironolactone: TOPCAT or underdog?

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Kathleen Faulkenberg
1:23-5:45: Overview of TOPCAT
5:46-8:28: Kathleen’s Overall Thoughts 
8:29-10:11: TOPCAT Controversy
10:12-11:15: Spironolactone Metabolite Differences Between Regions
11:16-11:59: More Questions Around TOPCAT
12:00-12:51: What do we do with results from TOPCAT?
12:52-15:19: Final Thoughts
15:20-16:01: Closing


References:

  • TOPCAT: Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med 2014;370:1383-92.
  • de Denus S, Desai AS, Leclair G, et al. Spironolactone Metabolites in TOPCAT – New Insights into Regional Variation. N Engl J Med 2017;376:1690-1692.
  • Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 2015;131(1):34-42.
  • Cohen JB, Schrauben SJ, Zhao L, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC Heart Fail 2020; DOI: 10.1016/j.jchf.2019.09.009.

Plenty of fish [oil] in the sea, have we REDUCEd-IT to one?

Check out this episode as Dr. Dave Dixon talks about REDUCE-IT and REDUCE-IT USA. 


0:00-0:41: Intro
0:42-1:26: Introduction of Dr. Dave Dixon
1:27-5:10: Introduction of REDUCE-IT and REDUCE-IT USA
5:11-6:30: Dave’s Initial Thoughts
6:31-8:21: Why not OTC fish oil or omega-3 fatty acid prescriptions?
8:22-9:54: Were these patients well managed at baseline?
9:55-11:15: Who should we avoid icosapent ethyl in?
11:16-12:19: Labeling Changes
12:20-14:16: Final Thoughts
14:17-15:01: Closing


References:
REDUCE-IT: Bhatt DL, Steg G, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med2019;380:11-22.
REDUCE-IT USA: 
Bhatt DL, Miller M, BrintonE, et al. REDUCE-IT USA: Results from the 3,146 Patients Randomized in the United States. Circulation 2019; doi: 10.1161/CIRCULATIONAHA.119.044440. 
FDA New Release: https://www.fda.gov/news-events/press-announcements/fda-approves-use-drug-reduce-risk-cardiovascular-events-certain-adult-patient-groups 

In Zac Noel we ENTRUST: Double or Nothing?

In this episode, Dr. Zac Noel helps us navigate through the ENTRUST-AF PCI trial as well as dual vs. triple antithrombotic therapy.



0:00-0:40: Intro
0:41-1:42: Introduction of Dr. Zachery Noel
1:43-4:35: ENTRUST-AF PCI Overview
4:36-5:46: Zac’s Overall Thoughts
5:47-6:33: Dual antithrombotic therapy for everyone?
6:34-7:38: Patient population in ENTRUST-AF PCI
7:39-9:03: Other P2Y12 inhibitors
9:04-10:13: Ischemic outcomes
10:14-11:18: Who should receive dual antithrombotic therapy?
11:19-14:28: Zac’s Final Thoughts
14:29-15:38: Closing/New Year’s Resolutions


References:

  • ENTRUST AF-PCI: Vranckx P, Valgimigli M, Tijssen J, et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019;394(10206):1335-43.
  • AUGUSTUS: Lopes RD, Heizer G, Aronson R, et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med 2019;380(16):1509-24. 
  • PIONEER AF-PCI: Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2019;375(25):2423-34.
  • RE-DUAL: Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.  N Engl J Med 2017;377(16):1513-1524.
  • WOEST: Dewilde WJ, Oirbans T, Verheugt FW, et al. Lancet 2013;381(9872):1107-15.
  • Dual vs. Triple Antithrombotic Therapy Meta-Analysis: Lopes RD, Hong H, Harskamp RE, et al. Safety and Efficacy of Antithrombotic Strategies in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol 2019;4(8):747-55.

Entering the TWILIGHT Zone

Prepare to dive into the TWILIGHT trial with Dr. Craig Beavers.

0:00-0:22: Intro
0:23-1:01: Introduction of Dr. Craig Beavers
1:02-3:32: TWILIGHT Overview
3:33-6:31: Craig’s Overall Thoughts
6:32-8:39: Excluded Patients
8:40-10:17: Ticagrelor Monotherapy and Ischemic Outcomes
10:18-12:52: TWILIGHT and GLOBAL LEADERS
12:53-14:24: Final Thoughts
14:25-15:22: Closing/Craig’s Upcoming Podcast

References:

  • TWILIGHT: Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019;381:2032-2042.
  • GLOBAL LEADERS: Vranckx P, Valgimigli M, Juni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018;392:940-49.

Episode is Live

Published: Dec. 24, 2019 @ 4AM EditUnpublish

Been there, done that: Expert advice from parting RPDs (Part 2)

In the second of two episodes, Drs. Rob DiDomenico and Kerry Pickworth provide their expertise about PGY2 Cardiology residency training.

0:00-0:40: Intro
0:41-2:46: Physical exam in the cardiology setting
2:47-6:17: Importance of interpreting diagnostic tests
6:18-9:02: Keeping up with literature
9:03-11:29: Importance of self-reflection
11:30-15:00: Final thoughts/Free time (?)

References: