The authors report on a U.S. registry of cardiac arrests during marathons and half-marathons. The rate of arrest was equal to or lower than rates for other strenuous physical activities. The most common cause was hypertrophic cardiomyopathy or coronary artery disease.

In a randomized trial, patients with an acute coronary syndrome were assigned to receive apixaban or placebo in addition to standard therapy. The apixaban group had a higher rate of TIMI major bleeding and no significant reduction in recurrent ischemic events.

In a large U.S.–Canadian registry of out-of-hospital cardiac arrests, shockable rhythms were more common in public settings than in the home. This finding has important implications for resuscitation strategies, especially the use of automated external defibrillators.

In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and imaging after PCI. Of 132 subsequent major adverse cardiovascular events, approximately half occurred at the site of the previous culprit lesion.

In this clinical trial of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR), results were similar with chest compressions alone and with chest compressions plus rescue breathing. However, patients with a cardiac cause of the arrest and those with shockable rhythms fared better with chest-compression-only CPR. These results are likely to influence clinical practice guidelines.

In a randomized clinical trial involving patients with out-of-hospital cardiac arrest, 30-day survival rates were similar when compression-only CPR was used and when standard CPR (compression and ventilation) was used. The results provide further support for a compression-only strategy.

In this clinical trial, the intravenous platelet inhibitor cangrelor was compared with oral clopidogrel in patients with acute coronary syndromes who were undergoing percutaneous coronary intervention (PCI). Cangrelor provided no benefit, as compared with clopidogrel, and was associated with more bleeding. This trial does not suggest a clinical advantage of cangrelor.

Cangrelor is an intravenous ADP-receptor blocker that interferes with platelet function. With a primary end point of death, myocardial infarction, or revascularization, cangrelor was not superior to placebo in patients undergoing PCI. However, there were fewer stent thromboses and deaths in the cangrelor group, leading the authors to suggest that cangrelor deserves further study.

In a multicenter, randomized trial, ticagrelor — a reversible inhibitor of the adenosine diphosphate receptor P2Y12 — was compared with clopidogrel in patients who had an acute coronary syndrome with or without ST-segment elevation. At 12 months, the primary end point of death from vascular causes, myocardial infarction, or stroke occurred less often with ticagrelor. Ticagrelor was not associated with an increase in the risk of major bleeding.

In a placebo-controlled trial, 497 patients undergoing vascular surgery were randomly assigned to receive either fluvastatin or placebo, both before surgery and for 30 days after surgery. Postoperative myocardial ischemia occurred significantly less frequently in the fluvastatin group. Fluvastatin was also associated with a reduction in the rate of death from cardiovascular causes or myocardial infarction.