TCTMD’s Top 10 Most Popular Stories for October 2021

The new chest pain guidelines took top billing in TCTMD’s top 10 for October 2021 followed by fresh data on the myocarditis risk with mRNA COVID-19 vaccines, which bumped our COVID-19 Dispatch to third spot. Dotted elsewhere in the list are some conspicuously outdated advice on aspirin in primary prevention, two stories from the European Association for Cardio-Thoracic Surgery (EACTS) 2021 meeting, a feature story on the rapid sequencing of heart failure medications, and a compelling analysis that undercuts the idea that nonfatal MI is a reliable surrogate for death in CV clinical trials.

1. New Chest Pain Guidelines Out at Last: Most Tests Have a Role

CT angiography gains a prominent role in the guidelines, but many other testing modalities get a class I indication, too.

2. Studies Highlight Rarity of Myocarditis With mRNA COVID-19 Vaccines

Data from the US and Israel show that cases were clustered in young men and typically followed a benign course.

3. TCTMD’s COVID-19 Dispatch

We update our Dispatch with the top research and health policy news, as well as media highlights, three times per week.

4. USPSTF at Last Takes Tougher Stance on Aspirin in Primary Prevention

The advice joins a range of prior documents, but cardiologists stress that aspirin is still needed for those who already have CVD.

5. Rivaroxaban Again Linked to More Bleeding vs Other DOACs

In the absence of head-to-head RCTs, experts say existing observational data should inform decision-making.

6. Left Main Guideline Review Looms as EACTS Surgeons Urge CABG First

Temperatures have cooled since EACTS 2019, and the ESC’s “good faith” evidence review is promised for early 2022.

7. Four Pillars, Fast? Rapid Sequencing of HF Drugs Faces an Uphill Battle

There are growing calls to initiate the “foundational” HFrEF drugs as soon as possible, but strategies have never been tested.

8. More Deaths With Bioprosthetic Than Mechanical AVR in Young AS Patients

Patients tend to want to avoid long-term anticoagulation, though later risks for death and repeat surgeries need to be factored in.

9. Device-Detected AF Directly Linked to Ischemic Strokes

The findings bolster calls from experts for new trials of time-limited, “pill-in-the-pocket” anticoagulation.

10. Nonfatal MI Not a Death Surrogate in Cardiology: Meta-analysis

Reducing MI doesn’t reduce mortality, data from more than 100 RCTs show, sparking introspection and debate.