Cardio Round-Up: Guidelines Address Chest Pain in Adults; and More

Assessing the Performance of Bleeding Scores in High-Risk VTE Patients

A study aimed to systematically evaluate the performance of bleeding scores in patients with VTE focusing on high-risk patients. The findings appeared in the European Journal of Internal Medicine.

Researchers searched Medline and Cochrane Library, as well as reviews and references of retrieved articles. They discerned sensitivity, specificity, positive likelihood ratio (LR+), and diagnostic odds ratio (DOR) of the ‘high risk’ category of each bleeding score. Subsequently, random effects meta-analysis w performed in order to derive the central estimates and 95% confidence intervals (95% CI). Overall, the analysis included 21 studies and 10 bleeding scores.

The results found that VTE-BLEED displayed the highest sensitivity, but the second-lowest specificity (Se 76%; Sp 61%), followed by ACCP (Se 59%; Sp 57%). The researchers observed that the remaining scores had high specificity (> 80%), but a low sensitivity (< 20%). HEMORR2HAGES and Niewenhuis score showed the best performance regarding LR+ that was 2.67 and 5.91, respectively. Regarding DOR, the Niewenhuis score and VTE-BLEED were the best performers with 9.04; 95% CI 3.87-21.09 and 4.94 95% CI 2.66-9.09, respectively. In a cohort with patients predominantly treated with direct oral anticoagulants (DOACs), VTE-BLEED had the highest sensitivity (Se 77%; Sp 60%).

Zero CAC Score Does Not Rule Out Atherosclerosis

Coronary computed tomography angiography (CCTA) can detect atherosclerosis, even among individuals with no coronary artery calcification (CAC), according to a study published online Sept. 20 in Circulation.

Göran Bergström, M.D., Ph.D., from the University of Gothenburg in Sweden, and colleagues recruited 30,154 randomly invited individuals aged 50 to 64 years to the Swedish Cardiopulmonary Bioimage Study, including those without known coronary heart disease and with high-quality results from CCTA and CAC imaging.

“A high CAC score means there is a high likelihood of having obstruction of the coronary arteries,” Bergström said in a statement. “However, more importantly, a zero CAC score does not exclude adults from having atherosclerosis, especially if they have many traditional risk factors of coronary disease.”

Assessing Non-vitamin K Antagonist Oral Anticoagulants in AFib Patients

Recent observational studies have compared the safety and efficacy profiles between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in patients with atrial fibrillation (AFib). However, confounders may exist due to the nature of clinical practice-based data, thus potentially influencing the reliability of results.

This study analyzed 20 propensity score-based observational studies and 4 RCTs which were obtained by systematically searching the PubMed and EMBASE databases. The primary endpoints were defined as stroke or systemic embolism (SSE) and major bleeding.

“Data from propensity score-based observational studies and NOAC trials consistently suggest that the use of four individual NOACs is non-inferior to warfarin for stroke prevention in AF patients,” the researchers concluded.

Guideline Addresses Diagnosis, Evaluation of Chest Pain in Adults

Transplant patients and certain other folks may need four shots of COVID-19 vaccine for optimal protection, new research suggests.

People with weakened immune systems who’ve received both doses of two-dose COVID-19 vaccines aren’t adequately protected against severe illness. They should be given a third shot plus a booster, according to the study.

“These findings indicate that while two doses of mRNA COVID-19 vaccines are beneficial in immunocompromised individuals, they are significantly less protected from severe disease than people with normal immune systems,” said study lead author Dr. Peter Embí. He is president of the Regenstrief Institute in Indianapolis and associate dean for informatics and health services research at Indiana University School of Medicine.