The role of high-sensitivity cardiac troponin I (hsTnI) in the evaluation of patients with possible acute coronary syndromes is evolving rapidly in emergency departments in other countries. Neumann and coworkers tested hsTnI levels in 1040 patients presenting with acute chest pain. Using a low and sensitive cutoff value of hsTnI, patients could be triaged within 1 hour with no loss of safety compared with a 3-hour approach, with very low mortality (0.99%) during the next 12 months. An accompanying Editorial by Morrow puts these data in perspective and discusses the expanding evidence base for incorporating these highly sensitive biomarkers in the emergency department.
Inflammation may contribute to the interfaces of obesity, diabetes, and cardiovascular disease. Hauser and coworkers report the results of a National Heart, Lung, and Blood Institute–sponsored prospective randomized trial, the Targeting Inflammation Using Salsalate in Cardiovascular Disease (TINSAL-CVD) trial, of salsalate vs placebo in 257 overweight and obese patients with stable coronary heart disease who were receiving statins. After 30 months, progression of noncalcified coronary artery plaque assessed by computed tomographic angiography did not differ between treatment and placebo groups. In an accompanying Invited Commentary, Ridker notes that neutral trials such as TINSAL-CVD are informative and deserve our attention, but it is possible that a different result might be obtained if patients received salsalate at an early rather than late stage of the disease process.
Many patients discontinue dual antiplatelet therapy, even when enrolled in clinical trials. Bonaca and coworkers explored circumstances of ticagrelor discontinuation in the PEGASUS-TIMI 54 trial. Over 33 months, roughly 30% of patients discontinued treatment in the ticagrelor arms compared with 21% in the placebo arm. The most frequent events leading to ticagrelor discontinuation were not considered serious—nonmajor bleeding and mild or moderate dyspnea—and most events occurred shortly after starting therapy. Granger and Berger write in an Editorial that tradeoffs between reduced stent thrombosis and ischemic events vs increased bleeding cause challenges for both physicians and patients, requiring thorough conversations of risks and benefits.
Author Audio Interview
Atrial fibrillation (AF) is a growing public health issue. Magnani and coworkers report that incident rates of AF were lower in black individuals than white individuals among 15 080 participants in the Atherosclerosis Risk in Communities (ARIC) Study, but the outcome of AF on adverse cardiovascular outcomes was considerably greater in black individuals, with higher rates of stroke, heart failure, and death. An Editorial by Stamos and Darbar emphasizes the need for additional investigation regarding the possible social, environmental, and genetic causes for these findings.
Highlights. JAMA Cardiol. 2016;1(4):373. doi:10.1001/jamacardio.2015.0020