News | December 23, 2014

Journal of the American College of Cardiology Notes Most Accessed Papers

Troponin-T, PCSK9-inhibitors, and surgery for leaky heart valves among top 2014 studies

December 23, 2014 — The most accessed research studies in the Journal of the American College of Cardiology (JACC) in 2014 spanned many topics, including a blood test to rule out heart attack, an advisory about guidelines for preventing high blood pressure, cutting-edge research on a new class of cholesterol drugs and a study that found benefits in early surgery for mitral regurgitation.

Reviewing articles accessed most often in JACC, the flagship journal of the American College of Cardiology (ACC), and the sub-specialty journals JACC: Cardiovascular Interventions; JACC: Cardiovascular Imaging; and JACC Heart Failure, is one way to reflect on the year in cardiology.

Here are the titles of the most read and accessed papers from the family of JACC journals in 2014:


  • Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction (doi:10.1016/j.jacc.2014.03.017)
    • Patients presenting to the emergency department with an undetectable level of high-sensitivity cardiac troponin T, and whose electrocariodgrams (ECGs) show no sign of restricted blood flow, have a minimal risk of heart attack within 30 days. The probability that patients with an undetectable level of the blood biomarker are not at risk was 99.8 percent for heart attack and 100 percent for death.


  • An Effective Approach to High Blood Pressure Control: A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention (doi:10.1016/j.jacc.2013.11.007)
    • This advisory calls on healthcare providers to work in close partnership with patients and to prioritize patients with high blood pressure who are receiving treatment but haven’t achieved their target blood pressure. The advisory encourage a team-based approach to care as well as evidence-based hypertension treatment algorithms and standardize protocols.


  • Long-Term Benefit of Early Pre-Reperfusion Metoprolol Administration in Patients With Acute Myocardial Infarction: Results From the METOCARD-CNIC Trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) (doi:10.1016/j.jacc.2014.03.014)
    • Conclusions:  In patients with anterior Killip class ?II ST segment elevation myocardial infarction (STEMI) undergoing pPCI (percutaneous coronary intervention), early IV metoprolol before reperfusion resulted in higher long-term left ventricular ejection fraction (LVEF), reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions.


  • Early Surgery Versus Conventional Treatment for Asymptomatic Severe Mitral Regurgitation: A Propensity Analysis (doi:10.1016/j.jacc.2014.02.577)
    • Conclusions:  Compared with conservative management, early surgery is associated with significant long-term reductions of cardiac mortality and cardiac events in asymptomatic severe MR. These benefits were evident among patients age 50 years of age and older.


  • Anti-PCSK9 Monotherapy for Hypercholesterolemia: The MENDEL-2 Randomized, Controlled Phase III Clinical Trial of Evolocumab (doi:10.1016/j.jacc.2014.03.018)
    • Conclusions: In the largest monotherapy trial using a PCSK9 inhibitor to date, evolocumab yielded significant low-density lipoprotein cholesterol (LDL-C) reductions compared with placebo or ezetimibe and was well tolerated in patients with hypercholesterolemia.


  • Anti-PCSK9 Antibody Effectively Lowers Cholesterol in Patients With Statin Intolerance: The GAUSS-2 Randomized, Placebo-Controlled Phase 3 Clinical Trial of Evolocumab (doi:10.1016/j.jacc.2014.03.019)
    • Evolocumab, an injected form of a class of drugs called PCSK9 inhibitors that lower low-density lipoprotein cholesterol, also known as LDL-C or “bad cholesterol,” outperformed ezetimibe with few side effects in patients unable to take statins.


  • Early Surgery or Watchful Waiting for Asymptomatic Severe Degenerative Mitral Regurgitation: Is the Answer Now Clear? (doi:10.1016/j.jacc.2014.03.003)
    • This editorial comment accompanies the study Early Surgery Versus Conventional Treatment for Asymptomatic Severe Mitral Regurgitation: A Propensity Analysis.


  • Short-Term Rosuvastatin Therapy for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Diabetes and Chronic Kidney Disease (10.1016/j.jacc.2013.09.017)
    • Conclusions: Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection.


  • Prognostic Value of Fractional Flow Reserve: Linking Physiologic Severity to Clinical
    Outcomes (doi:10.1016/j.jacc.2014.07.973)
    • Conclusions:  FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.


  • Aspirin Therapy in Primary Cardiovascular Disease Prevention: A Position Paper of the European Society of Cardiology Working Group on Thrombosis (doi:10.1016/j.jacc.2014.03.049)
    • Conclusions and Recommendations: We recommend that aspirin use in the primary prevention of acute MI and other atherothrombotic cardiovascular events in subjects of both sexes is guided by an assessment of the underlying cardiovascular risk. We suggest that aspirin be considered in the primary prevention of CVD in both sexes at a level of risk of major cardiovascular events (death, MI, and stroke) >2 per 100 subject-years, provided they have no clear evidence of increased risk of bleeding.



  • Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Practical Considerations for Diagnostic Tests (doi:10.1016/j.jcin.2014.01.157)
    • Conclusions: The failure to detect fixed obstructive CAD in patients with angina and signs of myocardial ischemia is a frequent clinical scenario that can be due to different mechanisms… The intracoronary acetylcholine test allows at the same time the assessment of a possible epicardial vasospasm and endothelium-dependent microvascular dysfunction. Similarly, the use of a pressure wire with the adenosine test may evaluate both the functional significance of a coronary lesion and endothelium-independent microvascular dysfunction.  


  • The “Chicken Little” of Renal Stent Trials: The CORAL Trial in Perspective (doi:10.1016/j.jcin.2013.12.002)
    • Chris White, M.D., associate editor of JACC: Interventions, puts the findings of the CORAL Trial into perspective



  • Exercise Testing in Asymptomatic Severe Aortic Stenosis (doi:10.1016/j.jcmg.2013.08.011)
    • Conclusions: In asymptomatic patients with severe AS, exercise stress test and exercise stress echocardiography may provide incremental clinical and prognostic value, in addition to physical examination and resting echocardiography. Exercise stress test may identify resting asymptomatic patients who develop exercise abnormalities and in whom surgery may be recommended according to current guidelines. Exercise stress echocardiography may further unmask a subset of asymptomatic patients who are at high risk of reduced cardiac event free survival. In these patients, early surgery may be beneficial, whereas regular follow-up seems more appropriate in patients without echocardiographic abnormalities during exercise.


  • Redefining Diastolic Dysfunction Grading: Combination of E/A =0.75 and Deceleration Time (doi:10.1016/j.jcmg.2014.05.002)
    • Conclusions:  The new DD grade is frequently observed and has a prognosis similar to that of the pseudonormal group but significantly worse than that of the impaired relaxation group. However, LA booster function was maintained at the expense of LA volume enlargement. Thus, the new grade should be a distinct entity for routine DD grading.



  • Developing Therapies for Heart Failure With Preserved Ejection Fraction: Current State and Future Directions (doi:10.1016/j.jchf.2013.10.006)
    • Conclusions: HFpEF prevalence is increasing, and these patients face impaired health status and an unabated high risk for adverse outcomes. The economic burden of HFpEF is substantial. To date, there is no approved therapy for these patients. To identify new therapies, a deeper understanding of the subpopulations that fit under the HFpEF umbrella, and more specific molecular targets for engagement, are needed.


  • Antiplatelet and Anticoagulant Agents in Heart Failure: Current Status and Future Perspectives (doi:10.1016/j.jchf.2013.07.007)
    • This state-of-the art paper explores the evidence for targeting the inhibition of platelet function and coagulation to improve outcomes in the HF patient.


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