Updates 16 Feb 2016

Twenty-year follow up of Primary Prevention with Statins
The WOSCPS trial was a primary prevention study of the benefit of statins in 45-64 years old men with elevated LDL cholesterol. The initial study reported clear benefit of statin use in reducing adverse cardiovascular events up to five years. Now, the twenty-years outcomes are reported according to initial intention to treat and show persistent benefit with reduced all-cause mortality and 21% reduction in cardiovascular death as well as lower hospitalization rates in those assigned to statin therapy.

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Prognostic Utility of Plasma PCSK9 levels in Patients with Acute Coronary Syndrome
The enzyme proprotein convertase subtilisin kinase 9 (PCSK9) increases lysosomal degradation of LDL receptors, thereby increasing plasma LDL levels. A multicentre study of 2030 patients admitted with an acute coronary syndrome examined the relationship between plasma PCSK9 levels and clinical outcomes at 1 year. Higher PCSK9 levels were associated with higher incidence of familial hypercholesterolemia, higher plasma CRPO levels. Patients with higher PCSK9 levels were less likely to reach target cholesterol levels with statin treatment. The presence of higher PCSK9 levels was not, however, associated with increased mortality risk at one year.

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Outcomes for Acute MI in Regional and Remote Hospitals
A retrospective study of 9,393 patients presenting with acute MI to regional or remote hospitals in NSW has reported poorer outcomes than for those presenting to metropolitan hospitals. Those in regional and remote areas were less likely to receive revascularisation treatment and amongst those presenting with STEMI the mortality was increased (HR=1.14). The authors concluded that there was a need for prioritizing transfer of STEMI patients after fibrinolysis to a PCI capable centre.

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Predictors of Valve Hemodynamic Deterioration after TAVR
A multicentre registry report of 1521 patients receiving TAVR with follow up for a mean of 20 months describes a small incidence of valve hemodynamic deterioration (4.5%) manifest as > 10 mmHg increase in mean transprosthetic gradient. Patients who did not receive anticoagulants, those with a valve-in-valve procedure and those receiving a 23 mm transcatheter valve appeared to be at greater risk of valve hemodynamic deterioration.

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