Volume 11 Issue 2, February 2014

Catheter-based revascularization has emerged as the gold-standard therapy for most patients with acute coronary syndromes (ACS). Optimizing outcomes in these patients requires appropriate adjunctive pharmacological therapy and percutaneous coronary intervention. Five studies published in 2013 are expected to have a major effect on treatment and prognosis of patients with ACS.

In 2013, clinical trials in heart failure focused on drugs and devices that might improve treatment of symptomatic patients beyond standard therapy. None achieved this aim. Therefore, future efforts should emphasize increased adherence to current, evidence-based therapy, and trials might better address efforts to prevent, rather than treat, heart failure.

New findings published in 2013 strongly support the use of novel oral anticoagulants in the treatment of thromboembolic disorders. These drugs have been shown to have a more-favourable benefit-to-risk profile than older compounds, enabling their use from the start of treatment and in the whole spectrum of clinical presentations.

The new ACC/AHA guidelines on treatment of blood cholesterol focus on intensity of statin therapy rather than target levels of lipids. Early studies show substantial reductions in LDL-cholesterol level with antibodies against PCSK9. MicroRNA silencing and gene-repair techniques to treat dyslipidaemia are promising strategies under development.

In 2013, advances in noninvasive imaging methods pushed traditional boundaries in the detection, diagnosis, and functional assessment of coronary artery disease, atherosclerotic plaque, and myocardial function. We highlight five important studies that demonstrate how these developments are allowing medicine to become increasingly evidence-based and personalized.

Patients with chronic coronary artery disease can develop angina that is refractory to standard medical treatment. Henry and colleagues review the novel treatment strategies being developed for those individuals who are not suitable candidates for traditional revascularization, including pharmacological metabolic modulation, therapeutic angiogenesis, neuromodulation, and other invasive and noninvasive techniques.

Ventricular tachyarrhythmias are a leading cause of sudden cardiac death (SCD). In this Review, Bezzina et al. discuss the genetics of SCD, and how gene discovery programmes will contribute to the identification of novel genes involved in SCD in the coming years.

Endovascular aneurysm repair has become the standard of care in many hospitals for patients with abdominal aortic aneurysms (AAAs) who have anatomy deemed suitable for the procedure. In this Review, Dominique Buck and colleagues discuss evidence-based practice and evaluate promising new strategies for endovascular repair of AAAs. The role of imaging in the management of AAAs is also highlighted.