The edition · Cardiology
Calcium scoring earns its place at borderline PREVENT risk
Adding a calcium score to PREVENT barely moves overall prediction but splits borderline-risk patients sharply, while pooled tenecteplase data put numbers on age, dose and blood pressure as bleeding risks.
The edition in brief
In 6,098 MESA participants followed for ten years, adding a coronary artery calcium score to the PREVENT atherosclerotic risk equations raised the C statistic only from 0.73 by 0.02 overall. But within the borderline band, 3% to under 5%, event rates ran from 1.9% with a score of zero to 14.3% with a score of 300 or more — the case for selective scanning that the 2026 dyslipidaemia guideline makes. A pooled analysis of 15,954 STEMI patients from six tenecteplase trials found that intracranial haemorrhage risk rose about 2% per mmHg of systolic pressure above 110, sharply above 160, and climbed more steeply with age at the full 50 mg dose; female sex and low body weight added risk. A network meta-analysis of five trials found oral PCSK9 inhibitors lowered LDL cholesterol by up to about 60% against placebo, with no short-term safety signal and low-certainty comparisons between agents. The CHIPS trial found platelets cold-stored for up to 21 days were non-inferior to room-temperature platelets for bleeding in cardiac surgery, with more re-explorations. The 2026 US perioperative guideline for non-cardiac surgery replaces the 2014 version. The pearl covers how to talk about a zero calcium score.
Who bleeds into the brain after tenecteplase
Before fibrinolysis, bring systolic pressure down and consider a reduced tenecteplase dose in older patients.
Oral PCSK9 inhibitors: how far LDL falls
Oral PCSK9 inhibitors lower LDL about as much as injectables in short trials; outcome data and approvals will decide their place.
Cold-stored platelets in cardiac surgery
Cold-stored platelets are a credible way to extend platelet supply for cardiac surgery, with re-exploration to watch.
The 2026 US perioperative guideline replaces 2014
Update pre-operative assessment pathways to the 2026 guideline, which replaces the 2014 version.
Talking through a zero calcium score
Use a zero score to support deferring a statin only in borderline or intermediate-risk patients without high-risk features.
Where a calcium score changes the PREVENT decision
Order a calcium score where PREVENT puts a patient between 3% and 10%; outside that band it rarely changes the decision.
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