Edetate Disodium-Based Chelation for Patients With a Previous Myocardial Infarction and Diabetes: TACT2 Randomized Clinical Trial.

Importance: In 2013, the Trial to Assess Chelation Therapy (TACT) reported that edetate disodium (EDTA)-based chelation significantly reduced cardiovascular disease (CVD) events by 18% in 1708 patients with a prior myocardial infarction (MI). Objective: To replicate the finding of TACT in individuals with diabetes and previous MI. Design, Setting, and Participants: A 2 × 2 factorial, double-masked, placebo-controlled, multicenter trial at 88 sites in the US and Canada, involving participants who were 50 years or older, had diabetes, and had experienced an MI at least 6 weeks before recruitment compared the effect of EDTA-based chelation vs placebo infusions on CVD events and compared the effect of high doses of oral multivitamins and minerals with oral placebo. This article reports on the chelation vs placebo infusion comparisons. Interventions: Eligible participants were randomly assigned to 40 weekly infusions of an EDTA-based chelation solution or matching placebo and to twice daily oral, high-dose multivitamin and mineral supplements or matching placebo for 60 months. This article addresses the chelation study. Main Outcomes and Measures: The primary end point was the composite of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. Median follow-up was 48 months. Primary comparisons were made from patients who received at least 1 assigned infusion. Results: Of the 959 participants (median age, 67 years [IQR, 60-72 years]; 27% females; 78% White, 10% Black, and 20% Hispanic), 483 received at least 1 chelation infusion and 476 at least 1 placebo infusion. A primary end point event occurred in 172 participants (35.6%) in the chelation group and in 170 (35.7%) in the placebo group (adjusted hazard ratio [HR], 0.93; 95% CI, 0.76-1.16; P = .53). The 5-year primary event cumulative incidence rates were 45.8% for the chelation group and 46.5% for the placebo group. CV death, MI, or stroke events occurred in 89 participants (18.4%) in the chelation group and in 94 (19.7%) in the placebo group (adjusted HR, 0.89; 95% CI, 0.66-1.19). Death from any cause occurred in 84 participants (17.4%) in the chelation group and in 84 (17.6%) in the placebo group (adjusted HR, 0.96; 95% CI, 0.71-1.30). Chelation reduced median blood lead levels from 9.03 µg/L at baseline to 3.46 µg/L at infusion 40 (P < .001). Corresponding levels in the placebo group were 9.3 µg/L and 8.7 µg/L, respectively. Conclusions and Relevance: Despite effectively reducing blood lead levels, EDTA chelation was not effective in reducing cardiovascular events in stable patients with coronary artery disease who have diabetes and a history of MI. Trial Registration: ClinicalTrials.gov Identifier: NCT02733185.

Ultrasound-Accelerated Catheter-Directed Thrombolysis.

Venous thromboembolism is a very common presentation in the hospital setting. In patients with high-risk pulmonary embolism (PE) or PE and hemodynamic instability, systemic thrombolytic treatment is generally indicated. In those with contraindications to systemic thrombolysis, catheter-directed local thrombolytic therapy and surgical embolectomy are currently considered. In particular, catheter-directed thrombolysis (CDT) is a drug delivery system coupling the endovascular drug administration nearby in the thrombus and the local facilitating effect of ultrasounds. The applications of CDT are currently debated. Here we provide a systematic review of the clinical utilization of CDT.

Factors Influencing Thirty-Day Readmission Rate in Patients With Heart Failure Exacerbation.

Background: The purpose of this study is to further investigate the leading causes of readmission at 30 days in heart failure exacerbation patients, along with associations to mortality and intensive care unit (ICU) admissions. Methods: A retrospective data analysis was performed on a total of 33,400 patients between January 1, 2016, and December 31, 2020. The primary endpoints were to determine whether guideline-directed medical therapy (GDMT), length of stay, and time to first diuretic affect readmission rates. Secondary endpoints include time to first chest X-ray, time to first echocardiogram, administration of intravenous fluids, diet, presence of cardiology consult, and ICU admission. Results: Patients who received GDMT had decreased likelihood of mortality (odds ratio (OR): 0.518; 95% confidence interval (CI): 0.394 - 0.682; P < 0.001). Patients who had an echocardiogram done within 1 day of admission had less likelihood of death (OR: 0.606; 95% CI: 0.483 - 0.759; P < 0.001). In addition, patients who had a cardiac diet during their hospitalization were 0.632 times less likely to experience mortality (95% CI: 0.502 - 0.797; P < 0.001). Patients that received their first intravenous diuretic 2 h or more after admission were 1.290 times as likely to be readmitted within 30 days (95% CI: 1.018 - 1.634; P = 0.035). In addition, patients that did not receive intravenous diuretics were even more likely to be readmitted within 30 days (OR: 1.555; 95% CI: 1.237 - 1.955; P < 0.01). Patients who were treated with GDMT had a decreased chance of being readmitted within 30 days (OR: 0.781; 95% CI: 0.647 - 0.944; P = 0.01). Conclusions: This study stresses the importance of initiating GDMT, cardiac diet, diuretics, and echocardiogram in timely manner.

Update on Wearable Cardioverter Defibrillator: A Comprehensive Review of Literature.

Despite the advancements in the prevention and treatment of cardiovascular diseases, sudden cardiac death (SCD) remains a leading cause of mortality and is accountable for approximately 15% of the total mortality in the USA. The prognosis after sudden cardiac arrest (SCA) varies significantly and depends largely on the underlying etiology and the rapidity and efficiency of resuscitation; however, the outcome remains poor for most of the patients. The main culprits for SCD are coronary heart disease (CHD) and heart failure with reduced ejection fraction (HFrEF). Patients with HFrEF and an ejection fraction (EF) of less than 35% are considered for an implantable cardioverter-defibrillator (ICD) placement if the EF does not improve. A wearable cardioverter defibrillator (WCD) commonly known as a life-vest is sometimes used as a bridging modality until an ICD is implanted. The indication and utility of WCD is still a controversial topic. The purpose of this article is to provide an up-to-date comprehensive review of literature for WCD utilization.

Dronedarone for Atrial Fibrillation Prophylaxis in Patients Undergoing Open Heart Surgical Interventions: A Case Series.

Atrial fibrillation (a-fib) is one of the most frequently encountered and studied arrhythmias in medicine. The presence of A-fib in the post-operative period of coronary artery bypass graft (CABG) surgery is of particular concern for clinicians as this presents risks of post-operative stroke, hospital readmission, or anticoagulation dilemmas depending on the patient's comorbidities. In this case study, we present 5 patients who were treated with dronedarone prior to undergoing open heart procedures. We subsequently followed each patients clinical course paying close attention for any evidence of post-operative a-fib.

Low-Level Metal Contamination and Chelation in Cardiovascular Disease-A Ripe Area for Toxicology Research.

Cardiovascular disease remains the leading cause of death worldwide. In spite of cardiovascular prevention, there is residual risk not explicable by traditional risk factors. Metal contamination even at levels previously considered safe in humans may be a potential risk factor for atherosclerosis. This review examines evidence that 2 metals, lead, and cadmium, demonstrate sufficient toxicological and epidemiologic evidence to attribute causality for atherosclerotic disease. Basic science suggests that both metals have profound adverse effects on the human cardiovascular system, resulting in endothelial dysfunction, an increase in inflammatory markers, and reactive oxygen species, all of which are proatherosclerotic. Epidemiological studies have shown both metals to have an association with cardiovascular disease, such as peripheral arterial disease, ischemic heart disease, and cardiovascular mortality. This review also examines edetate disodium-based chelation as a possible pharmacotherapy to reduce metal burden in patients with a history of cardiovascular disease and thus potentially reduce cardiovascular events.

Challenges in Managing Acute Myocardial Infarction Associated With Infective Endocarditis: A Case Report.

Acute myocardial infarction (AMI) is a rare but recognized and potentially serious complication of infective endocarditis (IE). This case describes the challenges surrounding the management of AMI in the setting of septic coronary embolism, brain, spleen, and kidney infarcts due to septic emboli from native mitral valve IE.

Research and Data Mining During the COVID-19 Pandemic.

Description With the recent advances in information and technology systems, most developed countries have invested in building advanced systems for the management of electronic medical records. If the infrastructure of these systems are well designed, they both serve as an information resource for routine patient care and also serve as the primary backbone for medical research. This evidence became clear during the recent coronavirus pandemic, which has been a worldwide challenge since the beginning of 2020. Rapid spread of SARS-CoV-2 infections all over the world has resulted in tremendous health, economic and social ramifications, including social distancing, travel restrictions and closing of schools and businesses. Medical educational activities have shifted towards telemedicine, online learning and web-based meetings and conferences to prevent virus spread. While experimental lab research slowed, research with electronic medical records and databases accelerated in order to investigate the risk factors associated with COVID-19 and clinical management strategies to combat the disease. The urgency for COVID-related research has also lead to inconsistent and sometimes inaccurate output.

Cell therapy and satellite centers: the Cardiovascular Cell Therapy Research Network experience.

Due to the changing population in patients with myocardial infarction, recruiting patients in clinical trials continues to challenge clinical investigators. The Cardiovascular Cell Therapy Research Network (CCTRN) chose to expand the reach and power of its recruitment effort by incorporating both referral and treatment satellite centers. Eight treatment satellites were successfully identified and they screened patients over a two year period. The result of this effort was an increase in recruitment, with these treatment satellites contributing 30% of the patients to two of the three Network studies. The hurdles that these satellite treatment centers faced and how they surmounted them provide instruction to clinical research groups eager to expand to satellite systems and to health care practitioners who are interested in taking part in multicenter clinical trials.