This Week in Cardiology: Stroke Prevention, Kawasaki Disease, and Long-term Antiplatelet Therapy

This week's research offers nuanced insights into procedural risks and pharmacological strategies for cardiovascular care. From the New England Journal of Medicine, a trial ^[2] evaluated asundexian added to standard antiplatelet therapy in patients with noncardioembolic ischemic stroke or high-risk TIA. The study found a lower incidence of recurrent ischemic stroke in the treatment group compared with placebo, while major bleeding rates remained similar. The authors note that these findings support the potential benefit of this approach, though further context is needed before widespread adoption.

Meanwhile, another study from the New England Journal of Medicine ^[4] examined the role of steroids in Kawasaki disease. This multicenter trial evaluated 3208 participants with newly diagnosed Kawasaki disease in China. The study found that adding prednisolone to standard treatment did not significantly reduce the occurrence of coronary-artery lesions at 1 month compared to standard treatment alone. While fever duration and inflammatory markers improved with prednisolone, the primary cardiovascular outcome showed no significant benefit, suggesting caution in routine steroid use for this indication.

Elsewhere this week, attention turned to the chronic maintenance phase after percutaneous coronary intervention. In Lancet, researchers described ^[5] a 10-year extended follow-up of the HOST-EXAM randomized controlled trial. The analysis evaluated clopidogrel versus aspirin in 5,438 patients. The primary composite endpoint occurred less frequently with clopidogrel (25.4%) compared to aspirin (28.5%), with a hazard ratio of 0.86. These findings suggest clopidogrel may be a viable alternative to aspirin for long-term monotherapy, though all-cause mortality remained similar between groups.

Finally, a systematic review and meta-analysis in EuroIntervention ^[1] evaluated 290,039 patients undergoing myocardial revascularization. The analysis found that complex percutaneous coronary intervention (PCI) was associated with significantly higher risks of myocardial infarction, major bleeding, and all-cause death compared to non-complex PCI. These associations were observed across multiple outcomes, though certainty for stroke was lower. Clinicians should interpret these findings as associations rather than direct causal effects of the procedure itself. Additionally, a meta-analysis in Revista clinica espanola ^[3] evaluated the diagnostic utility of serum NT-proBNP levels for identifying congestive heart failure-related pleural effusions, suggesting it is a robust biomarker.