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Coronary sinus reduction for intractable angina

2 Mar, 15 | by Alistair Lindsay

An increasing number of patients have angina that is refractory to maximal medical therapy and unable to be addressed with revascularization procedures. Prior small studies have suggested the promise of generating a pressure gradient upstream of the myocardial venous drainage system to relieve angina.  This can be accomplished through the percutaneous implantation of a device that reduces the orifice for coronary sinus blood flow.  The Coronary Sinus Reducer for Treatment of Refractory Angina (COSIRA) trial randomized 104 patients with Canadian Cardiovascular Society (CCS) class III or IV angina, evidence of myocardial ischemia, and no remaining revascularization options to percutaneous implantation of a coronary sinus reducing device or a sham procedure in a double blind fashion. more…

Ivabradine ineffective as add-on therapy for stable ischemic heart disease  

20 Dec, 14 | by Alistair Lindsay

Ivabradine reduces heart rate without affecting blood pressure or left ventricular systolic performance. Given studies demonstrating a relationship between heart rate and cardiovascular risk, modifying heart rate with ivabradine may reduce risk in patients with coronary disease. In the Study Assessing the Morbidity–Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease (SIGNIFY) trial, patients with coronary artery disease, a heart rate of 70 bpm or more, and without heart failure, were studied to assess whether they would benefit from ivabradine. In this large international randomized controlled trial,19102 eligible patients were randomized to placebo or ivabradine up to 10mg twice daily (mean dose 8.2±1.7 mg twice daily) in addition to standard therapy that included beta-blockers in over 80% of patients. more…

Exercise caution when using treadmill ECGs for angina assessment

15 Feb, 09 | by Alistair Lindsay

Prompt assessment and risk stratification is fundamental to the early management of patients presenting for the first time with suspected angina. Within the setting of rapid access chest pain clinics (RACPC), risk stratification is traditionally achieved by history taking, examination, resting ECG and exercise ECG (ex-ECG). However, it remains unclear whether the inclusion of resting and exercise ECG adds incrementally to the prognostic value achieved by history taking and physical examination alone. more…

ARIA suggests diagnostic angiography underused

14 Oct, 08 | by Alistair Lindsay

Deciding which patients presenting with chest pain should undergo diagnostic coronary angiography (DCA) is an everyday dilemma for the cardiologist.  In the ARIA (Appropriateness of Referral and Invesigation of Angina) study, Hemingway and colleagues used scoring criteria, based on patient-specific characteristics and validated by 2 panels of experts made up of 22 UK physicians, in order to identify situations in which referral for DCA was made appropriately. more…

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