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In This Issue of JAMA Cardiology
August 2019


JAMA Cardiol. 2019;4(8):719. doi:10.1001/jamacardio.2018.3210

Anatomical scoring systems for coronary artery disease complexity, such as the SYNTAX (Synergy Between Percutaneous Coronary Intervention [PCI] With Taxus and Cardiac Surgery) score, are established risk assessment tools but are cumbersome to compute manually for large data sets. Using the Veterans Administration Clinical Assessment Reporting and Tracking Program, Valle and coauthors developed an anatomical scoring system for use with registry data, allowing automatic score calculation and association with clinical outcomes among patients undergoing revascularization. From 2010 through 2017, 50 226 patients were evaluated, with 34 322 undergoing PCI and 15 904 undergoing coronary artery bypass grafting. After adjustment, the highest tertile of anatomical complexity was associated with increased hazard of major adverse cardiovascular and cerebrovascular events for PCI but not for coronary artery bypass grafting.

Author Audio Interview

Antithrombotic treatment of patients with atrial fibrillation (AF) and coronary artery disease is a challenge in clinical practice, particularly those with acute coronary syndrome or percutaneous coronary intervention (PCI). Lopes and coauthors performed a network meta-analysis of 4 randomized clinical trials of antithrombotic regimens, including a total of 10 026 patients. Compared with vitamin K antagonist (VKA) plus dual antiplatelet therapy, a regimen of non-VKA oral anticoagulant plus P2Y12 inhibitor was associated with less bleeding. Strategies omitting aspirin caused less bleeding without increase in ischemic events compared with those including aspirin. These results support use of non-VKA oral anticoagulant plus P2Y12 inhibitor for high-risk patients.

Observational studies reporting an association of low serum vitamin D levels with risk of cardiovascular disease (CVD) events are subject to confounding. Barbarawi and coauthors performed a meta-analysis of 21 placebo-controlled randomized clinical trials assessing associations of vitamin D supplementation with reduced CVD events and all-cause mortality, including 83 291 patients. Compared with placebo, vitamin D was not associated with reduced CVD events nor secondary end points of myocardial infarction, stroke, CVD mortality, or all-cause mortality. While supporting these conclusions, in an Invited Commentary, Quyyumi and Al Mheid point out that only 4 of 21 trials had prespecified primary CVD end points and, overall, were underpowered for CVD events.

Invited Commentary

Modifiable risk factors for valvular heart disease (VHD) are a topic of current interest. Using mendelian randomization of individual participant data in the UK Biobank, Nazarzadeh and coauthors assessed the association of systolic blood pressure with major VHD in 329 237 participants. A total of 3570 participants had a diagnosis of VHD (aortic stenosis, 1491; aortic regurgitation, 634; and mitral regurgitation, 1736). Each genetically associated 20–mm Hg increment in systolic blood pressure was associated with increased risk of aortic stenosis, aortic regurgitation, and mitral regurgitation, with no evidence for heterogeneity by type of valve disease. Sensitivity analyses confirmed the robustness of the association.