The edition · Cardiology
Four doses of dapagliflozin halved acute kidney injury after cardiac surgery
A Dutch randomised trial finds a striking perioperative kidney signal, a multicentre study rewrites how exercise echocardiography should be used in suspected HFpEF, and SMART-CHOICE 3 asks whether women do better on clopidogrel than aspirin.
The edition in brief
Today's cardiology edition opens with a Dutch multicentre randomised trial in which 784 adults undergoing elective cardiac surgery received either dapagliflozin 10 mg or placebo for four doses starting the day before surgery. Acute kidney injury within seven days fell from 52% to 28% (relative risk 0.54, 95% CI 0.45–0.65). Atrial fibrillation and reoperation rates were identical between groups. A multicentre study of 482 patients with unexplained dyspnoea then shows that current HFpEF scores combined with exercise echocardiography have sensitivity of only 55–60%, and that adding resting left atrial compliance with separate rule-in and rule-out cut points lifts sensitivity among definitively classified patients to 95–99% while cutting the proportion needing invasive exercise testing from about 60% to about 30%. The NATURE trial randomised 156 patients with ST-elevation myocardial infarction and large thrombus burden to stent-retriever thrombectomy plus PCI or PCI alone, and found smaller infarcts by CK-MB area under the curve, though left ventricular volumes and ejection fraction did not differ. A meta-analysis of 13 trials of exercise-based telerehabilitation improved peak oxygen uptake by 2.58 mL/kg/min but showed no convincing blood pressure effect, with GRADE certainty rated very low. The edition closes on a prespecified sex-stratified analysis of SMART-CHOICE 3, where clopidogrel monotherapy after PCI outperformed aspirin in women but the sex-by-treatment interaction was not significant.
Dapagliflozin before cardiac surgery halved postoperative acute kidney injury
In elective cardiac surgery, a four-dose perioperative course of dapagliflozin roughly halved creatinine-defined acute kidney injury — enough to justify a protocol discussion, not yet a unilateral change.
Exercise echocardiography misses four HFpEF patients in ten — unless you add atrial strain
Add left atrial reservoir strain to the exercise echo and read it against two thresholds — a result in the middle means invasive testing, not a negative study.
Stent-retriever thrombectomy shrank infarcts in heavy-thrombus STEMI, without moving ejection fraction
A promising surrogate result in a narrow group — keep primary PCI practice unchanged until an outcome trial reports.
Telerehabilitation improves fitness; the blood pressure claim does not hold
Offer telerehabilitation as access to rehabilitation, not as a substitute for a supervised programme, and manage blood pressure separately.
Write the antiplatelet stop date into the discharge summary
Put the antiplatelet stop date in writing at discharge, and tell the patient not to stop before dental or eye surgery without calling.
Clopidogrel beat aspirin after PCI in women — but the interaction test says treat everyone the same
Consider clopidogrel over aspirin as monotherapy after dual antiplatelet therapy in high-risk post-PCI patients, and make that choice for both sexes alike.
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