Cardio Trial Files: Potassium Control in AFACS, Sedentary Behaviour & BP, and Protamine After Transfemoral TAVI
Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery (TIGHT K)
O’Brien B et al. JAMA (August 2024)
Bottom Line: This open-label, noninferiority, randomized clinical trial aimed to determine whether a lower serum potassium concentration trigger for supplementation is noninferior to a high-normal trigger in preventing atrial fibrillation after cardiac surgery (AFACS). The study included 1690 patients with no history of atrial dysrhythmias scheduled for isolated coronary artery bypass grafting (CABG) surgery. The primary outcome was new-onset AFACS within the first 120 hours after surgery or until hospital discharge, and the results showed that the lower threshold of potassium supplementation was noninferior to the current practice of maintaining high-normal serum potassium levels. There was no increase in dysrhythmias or adverse clinical outcomes with the lower threshold.
Effects of Sedentary Behavior Reduction on Blood Pressure in Desk Workers (RESET-BP)
Gibbs BB et al. Circulation (August 2024)
Bottom Line: This 3-month randomized clinical trial aimed to investigate the effects of reducing sedentary behavior on blood pressure and pulse wave velocity in sedentary adults. A total of 271 desk workers, aged 18-65 years, with elevated blood pressure and low physical activity levels were randomized to either a sedentary behavior reduction intervention or a no-contact control group. The intervention included coaching, a wrist-worn activity prompter, and a sit-stand desk to replace 2-4 hours of sedentary behavior with standing and stepping. Results showed a decrease in sedentary behavior and increase in standing and stepping in the intervention group, but no significant changes in blood pressure or pulse wave velocity. Future studies may explore other methods of reducing sedentary behavior and clarify the association between standing and pulse wave velocity during work and non-work times.
Routine Protamine Administration for Bleeding in Transcatheter Aortic Valve Implantation (ACE-PROTAVI)
Vriesendorp PA et al. JAMA (August 2024)
Bottom Line: The ACE-PROTAVI trial was a double-blind, placebo-controlled randomized clinical trial that evaluated the efficacy and safety of routine protamine administration after transfemoral TAVI. The study included 410 patients at 3 Australian hospitals between December 2021 and June 2023 and had a 1-year follow-up period. The coprimary outcomes were the rate of hemostasis success and time to hemostasis, with the major secondary outcome being a composite of all-cause death, major and minor bleeding complications, and major and minor vascular complications after 30 days. The study found that routine protamine administration increased the rate of hemostasis success and decreased time to hemostasis, resulting in a reduction in minor vascular complications (absolute risk difference: 6.3%; 95% CI, 2.0%-10.6%; P = 0.006). The study also reported no adverse events associated with protamine use.
Cardio Trial Files Issue #CRD-2024-20
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