Archive for May, 2017

Chocolate Consumption and Apparent Atrial Fibrillation

Mostofsky et al (Heart Online First, published on May 23, 2017 as 10.1136/heartjnl-2016-310357) report a large population cohort study and assess the relationship between chocolate consumption and risk of apparent atrial fibrillation.



To evaluate the association between chocolate intake and incident clinically apparent atrial fibrillation or flutter (AF).


The Danish Diet, Cancer, and Health Study is a large population-based prospective cohort study. The present study is based on 55 502 participants (26 400 en and 29 102 women) aged 50–64 years who had provided information on chocolate intake at baseline.
Incident cases of AF were ascertained by linkage with nationwide registries.


During a median of 13.5 years there were 3346 cases of AF. Compared with chocolate intake less than once per month, the rate of AF was lower for people consuming 1–3 servings/month (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.82 to 0.98), 1
serving/week (HR 0.83, 95% CI 0.74 to 0.92), 2–6 servings/week (HR 0.80, 95% CI 0.71 to 0.91) and ≥1 servings/day (HR 0.84, 95% CI 0.65 to 1.09; p-linear trend <0.0001), with similar results for men and women.


Accumulating evidence indicates that moderate chocolate intake may be inversely associated with AF risk, although residual confounding cannot be ruled out.




Medically treated NSTEMI

Feldman et al (European Heart Journal: Acute Cardiovascular Care
2017, Vol. 6(3) 262–271) report on the characteristics and outcomes of patients presenting with a non ST elevation acute coronary syndrome.



Medically managed individuals represent a high-risk group among patients with non–ST-elevation acute myocardial infarction (NSTE-AMI). We hypothesized that prognosis in this group is heterogeneous, depending on whether medical management was decided with or without coronary angiography (CAG).


Using data from the French Registry of Acute ST-Elevation or Non–ST-Elevation Myocardial Infarction (FASTMI), we analysed data from 798 patients with NSTE-AMI who were medically managed (i.e. without revascularization during the index hospitalization). Patients were categorized according to the performance of CAG and, if performed, to the extent of coronary artery disease (CAD).


There were marked differences in baseline demographics, according to whether CAG was performed and to the extent of CAD. While the overall mortality rate at five years was high (56.2%), it differed greatly between groups,
with patients who did not undergo CAG having a higher mortality rate (77.4%) than patients who underwent CAG (36.7%, p<0.001), and a higher mortality rate even than patients with multivessel CAD (54.2%, p<0.001). By multivariable
analysis, non-performance of CAG was an independent predictor of all-cause mortality among medically managed NSTEAMI patients (adjusted hazard ratios (95% confidence intervals) 3.19 (1.79–5.67) at 30 days, 2.28 (1.60–3.26) at one year,
and 1.63 (1.28–2.07) at five years; all p<0.001).


Medically managed patients with NSTE-AMI are a heterogeneous group in terms of baseline characteristics and outcomes. The highest risk patients are those who do not undergo CAG. Non-performance of CAG is a strong predictor of death.




Another useful video from the EuroPCR


Related papers: here and here.

Categories: Uncategorized

Switching Dual Antiplatelet Therapy: TOPIC

Cuisset et al report the results of the TOPIC trial at EuroPCR 2017. This useful video:

The paper is available here.

Categories: Uncategorized

Bicuspid Aortic Valve Natural History; Rotational Atherectomy

Categories: Uncategorized

AF Screening

Freedman et al present a white paper from the AF-SCREEN International Collaborative. This important paper collates evidence for AF screening and provides insights into the risk of asymptomatic atrial fibrillation and the temporal relationship between AF and ischemic stroke.