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In 2011, both the PARTNER-A trial, in high-risk patients with severe aortic stenosis, and EVEREST II, in patients with mitral insufficiency, showed noninferiority of transcatheter interventions compared with surgery for the chosen primary end points. However, both of the trials, and important registry data, identified limitations of transcatheter valve interventions.
Major advances in the diagnosis of acute coronary syndromes (ACS) have occurred in 2011, but physicians treating ACS still walk the tightrope between efficacy and bleeding. Key publications have shed light on this delicate balance and heralded a new era of novel oral anticoagulants for the treatment of ACS.
In 2011, key trials with oral factor Xa inhibitors in patients with atrial fibrillation highlighted promising data on these novel anticoagulants. Patients with ≥1 stroke risk factors can be considered for oral anticoagulation. These novel, fixed-dose drugs are given without monitoring, so clinicians must learn to balance stroke and bleeding risks.
In the first of their two Reviews on cardiogenic shock in acute coronary syndromes, Stephen Westaby and colleagues discuss the evolving epidemiology of this condition, its clinical presentation, and predictors of outcome. They also explore the options for medical therapy and the potential role of therapeutic hypothermia in these patients.
The results of several hypertension studies published in 2011 have contributed to our knowledge on the risks of and treatment for this condition, including the effects of slow-wave sleep, nocturnal dosing of medication, variability in post-stroke blood-pressure reduction, and the impacts of a low-sodium diet.
Understanding mechanisms of cardiac remodeling, with the goal of developing therapies to stop or reverse its progression, has become a major objective for investigators of heart failure. In this Review, Dr Koitabashi and Professor Kass discuss the evidence for 'reverse remodeling' by existing therapies, and review novel approaches that are currently moving from preclinical to clinical trials.
