CIRC - A Fib and Risk of MI

 "Atrial Fibrillation and Risk of ST-Segment Elevation versus Non-ST Segment Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study"

"Conclusions—AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI."

http://circ.ahajournals.org/content/early/2015/04/27/CIRCULATIONAHA.114.014145.abstract 

Lancet - Ceftolozane-tazobactam vs Levofloxacin for complicated UTI

"Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI)"

"Interpretation

Treatment with ceftolozane-tazobactam led to better responses than high-dose levofloxacin in patients with complicated lower-urinary-tract infections or pyelonephritis."  

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62220-0/abstract

NEJM - Evolocumab in Reducing Lipids and CV Events

"Efficacy and Safety of Evolocumab in Reducing Lipids and Cardiovascular Events"

"CONCLUSIONS

During approximately 1 year of therapy, the use of evolocumab plus standard therapy, as compared with standard therapy alone, significantly reduced LDL cholesterol levels and reduced the incidence of cardiovascular events in a prespecified but exploratory analysis. (Funded by Amgen; OSLER-1 and OSLER-2 ClinicalTrials.gov numbers, NCT01439880 and NCT01854918.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1500858 

JAMA - Autism Occurrence With MMR Vaccine

"Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism"

"Conclusions and Relevance  In this large sample of privately insured children with older siblings, receipt of the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD."

https://jama.jamanetwork.com/article.aspx?articleid=2275444

Weekly Guideline - 2015 ACC Percutaneous Mechanical Circulatory Support Devices

"2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care"

http://content.onlinejacc.org/article.aspx?articleid=2240149

CIRC - "Sudden Cardiac Arrest During Sports Activity in Middle Age"

"Sudden Cardiac Arrest During Sports Activity in Middle Age"

"Methods and Results—Patients with SCA who were 35 to 65 years of age  . . .  Of the 1247 SCA cases, 63 (5%) occurred during sports activities at a mean age of 51.1±8.8 years, yielding an incidence of 21.7  . . . per 1 million per year.  . . . Survival to hospital discharge was higher for sports-associated SCA (23.2% versus 13.6%; P=0.04). Sports SCA cases presented with known preexisting cardiac disease in 16% and ≥1 cardiovascular risk factors in 56%, and overall, 36% of cases had typical cardiovascular symptoms during the week preceding the SCA.

Conclusions—Sports-associated SCA in middle age represents a relatively small proportion of the overall SCA burden, reinforcing the idea of the high-benefit, low-risk nature of sports activity. Especially in light of current population aging trends, our findings emphasize that targeted education could maximize both safety and acceptance of sports activity in the older athlete."

http://circ.ahajournals.org/content/131/16/1384.full

BMJ - "Prognostic capabilities of coronary computed tomographic angiography before non-cardiac surgery: prospective cohort study"

"Prognostic capabilities of coronary computed tomographic angiography before non-cardiac surgery: prospective cohort study"

"Conclusions
Though findings on coronary computed tomographic angiography can improve estimation of risk for patients who will experience perioperative cardiovascular death or myocardial infarction, findings are more than five times as likely to lead to an inappropriate overestimation of risk among patients who will not experience these outcomes. Perioperative myocardial infarction occurs across the spectrum of coronary artery disease, suggesting that there could be several pathophysiologic mechanisms."

http://www.bmj.com/content/350/bmj.h1907 

NEJM- Alirocumab in Reducing Lipids and Cardiovascular Events

"Efficacy and Safety of Alirocumab in Reducing Lipids and Cardiovascular Events"

"CONCLUSIONS

Over a period of 78 weeks, alirocumab, when added to statin therapy at the maximum tolerated dose, significantly reduced LDL cholesterol levels. In a post hoc analysis, there was evidence of a reduction in the rate of cardiovascular events with alirocumab. (Funded by Sanofi and Regeneron Pharmaceuticals; ODYSSEY LONG TERM ClinicalTrials.gov number, NCT01507831.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1501031

JAMA - Outcomes Bioprosthetic vs Mechanical MVR

"Survival and Outcomes Following Bioprosthetic vs Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years"

"Conclusions and Relevance  Among patients aged 50 to 69 years undergoing mitral valve replacement in New York State, there was no significant survival difference at 15 years in patients matched by propensity score who underwent mechanical prosthetic vs bioprosthetic mitral valve replacement. Mechanical prosthetic valves were associated with lower risk of reoperation but greater risk of bleeding and stroke. Even though these findings suggest bioprosthetic mitral valve replacement may be a reasonable alternative to mechanical prosthetic valve replacement in patients aged 50 to 69 years, the 15-year follow-up was insufficient to fully assess lifetime risks, particularly of reoperation."

https://jama.jamanetwork.com/article.aspx?articleid=2247145

Weekly Guideline - 2015 AHA "Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome""

"AHA Scientific Statement
Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome"

http://circ.ahajournals.org/content/131/12/1123.full

CIRC - "Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33°C Versus 36°C"

"Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33°C Versus 36°C"

"Conclusions—Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment–elevation myocardial infarction not having had a cardiac arrest." 

http://circ.ahajournals.org/content/131/15/1340.abstract  

BMJ - "Precision medicine to improve use of bleeding avoidance strategies and reduce bleeding in patients undergoing percutaneous coronary intervention"

"Precision medicine to improve use of bleeding avoidance strategies and reduce bleeding in patients undergoing percutaneous coronary intervention"

"Conclusions Prospective provision of individualized bleeding risk estimates was associated with increased use of bleeding avoidance strategies and lower bleeding rates. Marked variability between providers highlights an important opportunity to improve the consistency, safety, and quality of care."  

http://www.bmj.com/content/350/bmj.h1302

NEJM "Age of Transfused Blood in Critically Ill Adults"

"Age of Transfused Blood in Critically Ill Adults"

"CONCLUSIONS

Transfusion of fresh red cells, as compared with standard-issue red cells, did not decrease the 90-day mortality among critically ill adults. (Funded by the Canadian Institutes of Health Research and others; Current Controlled Trials number, ISRCTN44878718.)"  

http://www.nejm.org/doi/full/10.1056/NEJMoa1500704?query=featured_home 

JAMA - Folate & CVA Prevention

"Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China" 

"Conclusions and Relevance  Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels." 
https://jama.jamanetwork.com/article.aspx?articleid=2205876 

Weekly Guideline - 2014 AHA / ACC HTN in CAD

"Treatment of Hypertension in Patients With Coronary Artery Disease
A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension"

http://hyper.ahajournals.org/content/early/2015/03/30/HYP.0000000000000018

CIRC -

"Exposure to Parental Smoking in Childhood Is Associated With Increased Risk of Carotid Atherosclerotic Plaque in Adulthood"

"Conclusions—Children of parents who smoke have increased risk of developing carotid atherosclerotic plaque in adulthood. However, parents who exercise good smoking hygiene can lessen their child’s risk of developing plaque."

http://circ.ahajournals.org/content/131/14/1239.full  

BMJ - "Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study"

"Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study"

"Conclusion At one year the effectiveness of microdecompression is equivalent to laminectomy in the surgical treatment of central stenosis of the lumbar spine. Favourable outcomes were observed at one year in both treatment groups." 

http://www.bmj.com/content/350/bmj.h1603 

NEJM -

"Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults"

"CONCLUSIONS

Among patients with clinically suspected CAP admitted to non-ICU wards, a strategy of preferred empirical treatment with beta-lactam monotherapy was noninferior to strategies with a beta-lactam–macrolide combination or fluoroquinolone monotherapy with regard to 90-day mortality. (Funded by the Netherlands Organization for Health Research and Development; CAP-START ClinicalTrials.gov number,NCT01660204.)"

http://www.nejm.org/doi/full/10.1056/NEJMoa1406330

JAMA -

"Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens"

"Conclusions and Relevance  In this study of pathologists, in which diagnostic interpretation was based on a single breast biopsy slide, overall agreement between the individual pathologists’ interpretations and the expert consensus–derived reference diagnoses was 75.3%, with the highest level of concordance for invasive carcinoma and lower levels of concordance for DCIS and atypia. Further research is needed to understand the relationship of these findings with patient management." 

https://jama.jamanetwork.com/article.aspx?articleid=2203798

Weekly Guideline - 2014 ACEP Seizure in ED

"Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Seizures"

http://www.acep.org/Clinical---Practice-Management/Clinical-Policy--Critical-Issues-in-the-Evaluation-and-Management-of-Adult-Patients-Presenting-to-the-Emergency-Department-With-Seizures/

JACC - "Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity"

"Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity"

"Conclusions  The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery."

http://content.onlinejacc.org/article.aspx?articleID=2199424

BMJ - "Short term exposure to air pollution and stroke: systematic review and meta-analysis"

"Short term exposure to air pollution and stroke: systematic review and meta-analysis"

"Conclusion
Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke."  

http://www.bmj.com/content/350/bmj.h1295