CHARACTERISTICS AND OUTCOMES OF ROTATIONAL ATHERECTOMY IN A TERTIARY CARE CARDIOLOGY FACILITY IN PAKISTAN

Objectives: To retrospectively review the short term outcomes of rotational atherectomy in a high CathPCI Risk and high Syntax Population. Methodology: A total of 51 patients who underwent RA between 1st June 2017 and 31st April 2019 were retrospectively reviewed after approval from ethical review committee. Clinical follow up was obtained for procedural success and major adverse cardiovascular events (MACE) at 3 months. Results: Patients who underwent RA were high risk with a mean Syntax score 32.7±5.9 and mean NCDR CathPCI risk score of 51.1±13. The mean age of the patients were 70 years, majority were males (81%), type 2 diabetics (78%) with chronic kidney disease (52.7%), Non-ST elevated myocardial infarction (NSTEMI) (35%) and Syntax Score>32 (64.8%). Out of 37 individuals, procedural success was reported in all subjects except one in the high risk syntax group. At three months, MACE was reported in 4 patients. Out of these four, one was intra-procedural death, three had repeat myocardial infarction. Out of these three, two declined repeat revascularization and were managed medically. One patient died during admission despite repeat revascularization. Almost all MACE reported, occurred in patients with Syntax>32. Conclusion: Despite high risk Syntax and CathPCI scores, RA led to high immediate procedural success for PCI in calcified lesions at our hospital with infrequent MACE.

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Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey

Lipids in Health and Disease ◽

10.1186/s12944-021-01467-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hermann Yao ◽

Michel Farnier ◽

Laura Tribouillard ◽

Frédéric Chague ◽

Philippe Brunel ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Ldl Cholesterol ◽

Statin Treatment ◽

Lipid Lowering ◽

Syntax Score ◽

Lipid Lowering Therapy ◽

Lipid Clinic ◽

Acute Mi ◽

Artery Disease

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated. Methods The data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2). Results Although LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001). Conclusions FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.

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Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽

10.1161/circ.143.suppl_1.p019 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Yejin Mok ◽

Lena Mathews ◽

Ron C Hoogeveen ◽

Michael J Blaha ◽

Christie M Ballantyne ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

High Risk ◽

Risk Stratification ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Atherosclerotic Cardiovascular Disease ◽

Single Model ◽

History Of ◽

Very High

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.

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EFFECTIVENESS OF TICAGRELOR COMPARED TO CLOPIDOGREL IN REDUCING THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY HEART DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTION

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i9.20361 ◽

2017 ◽

Vol 9 (9) ◽

pp. 178 ◽

Cited By ~ 1

Author(s):

Hendra Wana Nur’amin ◽

Iwan Dwiprahasto ◽

Erna Kristin

Keyword(s):

Myocardial Infarction ◽

Coronary Heart Disease ◽

Percutaneous Coronary Intervention ◽

Heart Disease ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Population Based ◽

Major Adverse Cardiovascular Events ◽

Repeat Revascularization ◽

Percutaneous Coronary

Objective: Antiplatelet therapy is recommended in patients with coronary heart disease (CHD) who had the percutaneous coronary intervention (PCI) procedure to reduce major adverse cardiovascular events (MACE). There has been a lack of population-based studies that showed the superior effectiveness of ticagrelor over clopidogrel and similar studies have not been conducted in Indonesia yet. The aim of the study was to investigate the effectiveness of ticagrelor compared to clopidogrel in reducing the risk of MACE in patients with CHD after PCI.Methods: A retrospective cohort study with 1-year follow-up was conducted. 361 patients consisted of 111 patients with ticagrelor exposure and 250 patients with clopidogrel exposure. The primary outcome was MACE, defined as a composite of repeat revascularization, myocardial infarction, or all-cause death. The association between antiplatelet exposure and the MACE was analyzed with Cox proportional hazard regression, adjusted for sex, age, comorbid, PCI procedures and concomitant therapy.Results: MACE occurred in 22.7% of the subjects. Clopidogrel had a significantly higher risk of MACE compared with ticagrelor (28.8%, vs 9.0%, hazard ratio (HR): 1.96 (95% CI 1.01 to 3.81, p=0.047). There were no significant differences in risk of repeat revascularization (20.40% vs 5.40%, HR: 2.32, 95% CI 0.99 to 5.42, p = 0.05), myocardial infarction (11.60% vs 3.60%, HR: 2.08, 95% CI, 0.73 to 5.93, p = 0.17), and death (1.60% vs 1.80%, HR: 0.77, 95% CI, 0.14 to 4.25, p = 0.77).Conclusion: Clopidogrel had a higher risk of MACE compared to clopidogrel in patients with CHD after PCI, but there were no significant differences in the risk of repeat revascularization, myocardial infarction, and all-cause death.

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Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Medical Principles and Practice ◽

10.1159/000489399 ◽

2018 ◽

Vol 27 (5) ◽

pp. 459-465 ◽

Cited By ~ 1

Author(s):

Erdal Aktürk ◽

Lütfü Aşkın ◽

Hakan Taşolar ◽

Serdar Türkmen ◽

Hakan Kaya

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Nonfatal Myocardial Infarction ◽

Risk Scores ◽

Major Adverse Cardiovascular Events ◽

Syntax Score ◽

Percutaneous Coronary ◽

St Elevation

Objective: We evaluated the relationship between various risk scores (SYNTAX score [SS], SYNTAX score-II [SS-II], thrombolysis in myocardial infarction [TIMI] risk scores, and Global Registry of Acute Coronary Events [GRACE] risk scores) and major adverse cardiovascular events (MACE) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients, and points were added according to the predefined algorithm, taking into account the other 6 clinical variables being monitored (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral artery disease). Patients were classified into tertile 1 (SS < 22), tertile 2 (SS 23–32), and tertile 3 (SS > 32). Results: The group with high SS-II for PCI values in the risk scores were observed from tertile 1 to tertile 3 (from 25.0 ± 7.7 to 31.6 ± 9.4, p < 0.001, respectively). The SS-II score in patients with PCI was an independent predictor of MACE, in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis (OR 1.082, 95% CI 1.036–1.131, p < 0.001). The overall MACE, in-hospital mortality, and nonfatal myocardial infarction rates were significantly higher in the high SS-II for PCI group (p < 0.001). Conclusion: TIMI and GRACE risk scores were able to predict MACE. In addition to these, SS-II was also able to predict in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis.

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Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease

Stroke ◽

10.1161/strokeaha.120.030550 ◽

2020 ◽

Vol 51 (9) ◽

pp. 2620-2629 ◽

Cited By ~ 1

Author(s):

Vikram S. Kashyap ◽

Peter A. Schneider ◽

Mazin Foteh ◽

Raghu Motaganahalli ◽

Rasesh Shah ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Carotid Artery ◽

Death Rate ◽

Technical Success ◽

Protocol Population ◽

Procedural Success ◽

Intent To Treat ◽

Treat Population ◽

Stroke Death

Background and Purpose: Transcarotid artery revascularization (TCAR) is comprised of carotid artery stent placement with cerebral protection via proximal carotid artery clamping and reversal of cerebral arterial flow. The aim of the present study was to evaluate the safety and efficacy of TCAR performed by a broad group of physicians with variable TCAR experience. Methods: The ROADSTER 2 study is a prospective, open label, single arm, multicenter, postapproval registry for patients undergoing TCAR. Patients considered at high risk for complications from carotid endarterectomy with symptomatic stenosis ≥50% or asymptomatic stenosis ≥80% were included. The primary end point was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary end points included technical success and individual/composite rates of stroke, death, and myocardial infarction (MI). All patients underwent independent neurological assessments before the procedure, within 24 hours, and at 30 days after TCAR. An independent clinical events committee adjudicated all major adverse events. Results: Between 2015 and 2019, 692 patients (Intent to Treat Population) were enrolled at 43 sites. Sixty cases had major protocol violations, leaving 632 patients adhering to the Food and Drug Administration-approved protocol (per-protocol population). The majority (81.2%) of operators were TCAR naïve before study initiation. Patients underwent TCAR for neurological symptoms in 26% of cases, and all patients had high-risk factors for carotid endarterectomy (anatomic-related 44%; physiological 32%; both 24%). Technical success occurred in 99.7% of all cases. The primary end point of procedural success rate in the Intent to Treat population was 96.5% (per-protocol 97.9%). The early postoperative outcomes in the Intent to Treat population included stroke in 13 patients (1.9%), death in 3 patients (0.4%), and MI in 6 patients (0.9%). The composite 30-day stroke/death rate was 2.3%, and stroke/death/MI rate was 3.2%. In the per-protocol population, there were strokes in 4 patients (0.6%), death in one patient (0.2%), and MI in 6 patients (0.9%) leading to a composite 30-day stroke/death rate of 0.8% and stroke/death/MI rate of 1.7%. Conclusions: TCAR results in excellent early outcomes with high technical success combined with low rates of postprocedure stroke and death. These results were achieved by a majority of operators new to this technology at the start of the trial. Adherence to the study protocol and peri-procedural antiplatelet therapy optimizes outcomes. Longer-term follow-up data are needed to confirm these early outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02536378.

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Comparison of 30-Day MACE between Immediate versus Staged Complete Revascularization in Acute Myocardial Infarction with Multivessel Disease, and the Effect of Coronary Lesion Complexity

Medicina ◽

10.3390/medicina55020051 ◽

2019 ◽

Vol 55 (2) ◽

pp. 51

Author(s):

Cem Doğan ◽

Zübeyde Bayram ◽

Murat Çap ◽

Flora Özkalaycı ◽

Tuba Unkun ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Multivessel Disease ◽

Major Adverse Cardiovascular Events ◽

Syntax Score ◽

Complete Revascularization ◽

Multivariable Model ◽

Coronary Lesion

Background and objective: In patients with acute myocardial infarction and multivessel disease, the timing of intervention to non-culprit lesions is still a matter of debate, especially in patients without shock. This study aimed to compare the effect of multivessel intervention, performed at index percutaneous coronary intervention (PCI) (MVI-I) or index hospitalization (MVI-S), on the 30-day results of acute myocardial infarction (AMI), and to investigate the effect of coronary lesion complexity assessed by the Syntax (Sx) score on the timing of multivessel intervention. Materials and methods: We enrolled 180 patients with MVI-I, and 425 patients with MVI-S. The major adverse cardiovascular events (MACE) for this study were identified as mortality, nonfatal myocardial infarction, nonfatal stroke, acute heart failure, ischemia driven revascularization, major bleeding, and acute renal failure developed within 30 days. Results: The unadjusted MACE rates at 30 days were 11.2% and 5% among those who underwent MVI-I and MVI-S, respectively (OR 3.02; 95% confidence interval (CI) 1.51–6.02; p=0.002). Associations were statistically significant after adjusting for covariates in the penalized multivariable model (adjusted OR 2.06; 95%CI 1.02–4.18; p=0.043), propensity score adjusted multivariable model (adjusted OR 2.46; 95%CI 1.19–5.07; p=0.015), and IPW (adjusted OR 2.11; 95%CI 1.28–3.47; p=0.041). We found that the Syntax score of lesions did not affect the results. Conclusion: MVI-S was associated with a lower incidence of major adverse cardiovascular events within 30 days after discharge.

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Electrocardiographic Changes and Coronary Findings in Patients with Acute non-ST-Elevation Myocardial Infarction: A Cross-Sectional Study

Jundishapur Journal of Chronic Disease Care ◽

10.5812/jjcdc.103948 ◽

2020 ◽

Vol 9 (4) ◽

Author(s):

Fardin Mirbolouk ◽

Arsalan Salari ◽

Fatemeh Riahini ◽

Mani Moayerifar ◽

Sama Norouzi ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Significant Relationship ◽

St Elevation Myocardial Infarction ◽

Syntax Score ◽

Ecg Changes ◽

Left Circumflex Artery ◽

Electrocardiographic Changes ◽

St Elevation ◽

The Mean

Background: Despite significant improvements in diagnosis and treatment, non-ST-Elevation Myocardial Infarction (NSTEMI) is still one of the health problems in developed and developing countries. Objectives: The present study was performed to assess the electrocardiographic changes and coronary findings in patients with NSTEMI. Methods: The study enrolled 158 patients with NSTEMI diagnosis at the discharge time. Demographic characteristics and electrocardiographic changes were collected using a checklist from the medical records of the patients. The angiography data were used to calculate a syntax score for each patient. Finally, patients were divided into three groups based on this score: high risk >32, intermediate risk 22-32, and low risk < 22. Involved vessels, including the left anterior descending artery, Right Coronary Artery (RCA), Left Circumflex Artery (LCX), and the left main stem, were also determined. Results: The mean age of the patients was 60.68 ± 12.15 years. The LAD, LCX, and RCA were the most common involved vessels, in sequence. About 27.73, 67.15, and 5.12% of the patients were assigned to low, moderate, and high-risk groups, respectively. Statistically significant differences were observed in the frequencies of ECG changes (P = 0.003) and types of involved vessels (P < 0.001) between low, moderate, and high-risk patients. In addition, there were statistically significant differences in the mean syntax scores between different types of involved vessels (P < 0.001). Conclusions: The findings of the present study showed a significant relationship between the types of vessel involvement and syntax score. Also, there was a high prevalence of ST changes in precordial leads that may improve the sensitivity of diagnosis. We did not find any significant relationship between the frequencies of ECG changes based on the types of involved vessels.

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Optimal Timing of Invasive Coronary Angiography following NSTEMI

Journal of Interventional Cardiology ◽

10.1155/2020/8513257 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Thabo Mahendiran ◽

David Nanchen ◽

David Meier ◽

Baris Gencer ◽

Roland Klingenberg ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Real World ◽

Cardiovascular Outcomes ◽

Major Adverse Cardiovascular Events ◽

Optimal Timing ◽

High Risk Patients ◽

Significant Difference ◽

Risk Patients ◽

One Year

Objective. To obtain a real-world perspective of the optimal timing of angiography performed within 24 hours of admission with non-ST elevation myocardial infarction (NSTEMI). Background. Current guidelines recommend angiography within 24 hours of hospitalisation with NSTEMI. The recent VERDICT trial found that angiography within 12 hours of admission with NSTEMI was associated with improved cardiovascular outcomes among high-risk patients. We compared the outcomes of real-world NSTEMI patients undergoing angiography within 12 hours of admission with those of patients undergoing angiography 12 to 24 hours after admission. Methods. NSTEMI patients without life-threatening features who received angiography within 24 hours of admission were obtained from the SPUM-ACS registry, a cohort of consecutive patients admitted with acute coronary syndromes to four university hospitals in Switzerland. Cox models assessed for an association between door-to-catheter time and one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, and stroke). Results. Of 2672 NSTEMI patients, 1832 met the inclusion criteria. Among them, 1464 patients underwent angiography within 12 hours (12 h group) compared with 368 patients between 12 and 24 hours (12–24 h group). Multiple logistic regression identified out-of-hours admission as the only factor associated with delayed angiography. After 2 : 1 propensity score matching, 736 patients from the 12 h group and 368 patients from the 12–24 h group demonstrated no significant difference in rates of one-year MACE (7.7% vs. 7.3%, HR: 1.050, 95% CI 0.637–1.733, p=0.847). Stratification by GRACE score (>140 vs. ≤140) found no significant reduction in MACE among high-risk patients in the 12 h group (p for interaction = 0.601). Conclusions. In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of admission was not associated with improved one-year cardiovascular outcomes when compared with angiography 12 and 24 hours after admission, even among high-risk patients.

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Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54

European Heart Journal ◽

10.1093/eurheartj/ehz821 ◽

2019 ◽

Vol 41 (17) ◽

pp. 1625-1632 ◽

Cited By ~ 5

Author(s):

Remo H M Furtado ◽

Jose C Nicolau ◽

Giulia Magnani ◽

Kyungah Im ◽

Deepak L Bhatt ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Cardiovascular Death ◽

Coronary Stenting ◽

Baseline Risk ◽

Major Adverse Cardiovascular Events ◽

Prior Myocardial Infarction ◽

Efficacy Outcome ◽

History Of

Abstract Aims PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduced the risk of major adverse cardiovascular events (MACE), with an acceptable increase in bleeding, in patients with prior myocardial infarction (MI). While much of the discussion around prolonged DAPT has been focused on stented patients, patients with prior MI without prior coronary stenting comprise a clinically important subgroup. Methods and results This was a pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162 patients with prior MI (1–3 years) and additional high-risk features to ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. A total of 4199 patients had no history of coronary stenting at baseline. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. Patients without history of coronary stenting had higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.15–1.73, in the placebo arm]. The relative risk reduction in MACE with ticagrelor (pooled doses) was similar in patients without (HR 0.82, 95% CI 0.68–0.99) and with prior stenting (HR 0.85, 95% CI 0.75–0.96; P for interaction = 0.76). Conclusion Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. These data highlight the benefits of DAPT in prevention of spontaneous atherothrombotic events and indicate that long-term ticagrelor may be considered in high-risk patients with prior MI even if they have not been treated with stenting. ClinicalTrials.gov Identifier NCT01225562.

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Abnormal Glucose Tolerance in Prediabetes Patients with Acute Myocardial Infarction: Implications for Therapy

Journal of Endocrinological Science ◽

10.29245/2767-5157/2021/1.1115 ◽

2021 ◽

Vol 3 (1) ◽

pp. 16-21

Author(s):

Nitchakarn Laichuthai ◽

Ralph A. DeFronzo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Glucose Tolerance ◽

Cardiovascular Events ◽

Current Evidence ◽

Major Adverse Cardiovascular Events ◽

High Risk Population ◽

Abnormal Glucose Tolerance ◽

Glucagon Like Peptide 1

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

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