1. Maslove DM, Tang B, Shankar-Hari M, Lawler PR, Angus DC, Baillie JK, et al. Redefining critical illness. Nat Med 2022;28:1141–1148. Critical illness needs to be reframed. Owing to the rapid changes and multi-organ manifestations seen in critical illness, it is likely to be more complicated and to take a correspondingly greater effort than the precedents of oncology and cardiology. It is achievable, but it will require collaboration at a global scale–in reaching agreement on terminology and approaches to taxonomy, in creating shared data repositories to test and validate models and in incorporating models into randomized trials to evaluate causal inference. For all the upheaval it has created, COVID-19 has shown that such an aspiration in global research collaboration is not only desirable but also possible.
2. Kjaergaard J, Moller JE, Schmidt H, Grand J, Mølstrøm S, Borregaard B, et al. Bloodpressure targets in comatose survivors of cardiac arrest. N Engl J Med 2022; 387:1456–1466. Targeting a mean arterial blood pressure of 77 mm Hg or 63 mm Hg in patients patients who had been resuscitated from cardiac arrest did not result in significantly difference percentage of patients dying or having severe disability or coma.
3. P, Giustino G, Gorog DA, Gramegna M, et al. Anticoagulation for percutaneous ventricular assist device-supported cardiogenic shock: JACC review topic of the week. J Am Coll Cardiol 2022;79:1949–1962. The precarious balance between bleeding and thrombosis in percutaneous VAD–supported cardiogenic shock patients is often the main reason that patient outcomes are jeopardized, and there is a lack of data addressing optimal anticoagulation management strategies during percutaneous VAD support. Here, we present a parallel anti-Factor Xa/activated partial thromboplastin time-guided anticoagulation algorithm and discuss pitfalls of heparin monitoring in critically ill patients.
4. M, Scholz M, Krohn K, Buttner P, et al. Impact of clonal hematopoiesis in patients with cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 2022;80:1545–1556. Clonal hematopoiesis of indeterminate potential (CHIP) is frequent among AMI and cardiogenic shock (CS) patients and is associated with impaired clinical outcome. CHIP assessment may facilitate risk stratification in patients with CS and imply novel treatment targets.
5. DH, Medeiros JJF, Fan CS, Fung NL, et al. Clonal haematopoiesis is associated with higher mortality in patients with cardiogenic shock. Eur J Heart Fail 2022;24:1573–1582. Cardiogenic shock (CS) patients have high frequency of clonal hematopoiesis (CH) notably mutations in TET2 and ASXL1. This was associated with reduced survival and dysregulation of circulating inflammatory cytokines in those CS patients with CH.
6. The DISCHARGE Trial Group. CT or invasive coronary angiography in stable chest pain. N Engl J Med 2022;386:1591–1602. Among patients referred for invasive of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the Compute Tomography (CT) group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy.
7. Perera D, Clayton T, O’Kane PD, Greenwood JP, Weerackody R, Ryan M, et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N Engl J Med 2022;387:1351–1360. Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure.
8. Kelshiker MA, Seligman H, Howard JP, Rahman H, Foley M, Nowbar AN, et al. Coronary flow reserve and cardiovascular outcomes: a systematic review and metaanalysis. Eur Heart J 2022;43:1582–1593. Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.
9. Banning AP, Serruys P, De Maria GL, Ryan N, Walsh S, Gonzalo N, et al. Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. Eur Heart J 2022; 43:1307–1316. Use of the SYNTAX II PCI strategy in patients with de novo three-vessel disease led to improved and durable clinical results when compared to predefined patients treated with PCI in the original SYNTAX I trial. A predefined exploratory analysis found no significant difference in MACCE between SYNTAX II PCI and matched SYNTAX I CABG patients at 5-year follow-up.
10. Fearon WF, Zimmerman FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med 2022;386:128–37i. In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be non-inferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.
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