Current ACC/AHA guidelines recommend that in patients with stable angina, noninvasive testing is used to prove mild or moderate ischaemia prior to performing PCI. […]
Category: General cardiology
Polyunsaturated fatty acids improve outcome in heart failure
In the initial Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto miocardico (GISSI) trial, patients taking n-3 polyunsaturated fatty acids (PUFA) after myocardial infarction had a lower mortality rate than those in the control group. The purpose of the GISSI-HF trial was to determine if PUFA could improve morbidity and mortality in patients with symptomatic […]
Ezetimibe and Cancer: What is the risk?
The recent Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) Trial showed that the combined treatment had no impact on the progression of aortic stenosis – but an excess of incident cancers was identified in the simvastatin-ezetimibe group when compared to placebo (105 vs 70, p=0.01). Deaths from cancer were also more frequent in the simvastatin-ezetimibe […]
Beta-blockers could increase risk in noncardiac surgery
Many trials have suggested a protective role for beta-blockade in noncardiac surgery, and the current ACC/AHA guidelines recommend their use in high-risk patients. However, preliminary results from the recent POISE (Perioperative Ischemic Evaluation (POISE) trial showed a higher incidence of total deaths and stroke in patients receiving peri-operative bera-blockade compared with placebo. […]
Anticholinergics increase risk of cardiovascular death
Inhaled anticholinergics – such as ipratropium or tiotropium bromide – are commonly prescribed to patients with chronic obstructive pulmonary disease (COPD). A previous analysis of 19 short-term placebo-controlled trials had suggested a possible increased risk of stroke with inhaled tiotropium, therefore Singh et al. performed a meta-analysis of 17 trials enrolling 14783 patients in order […]
Breaking the rules – when to terminate cardiac arrest
Reported rates of survival following cardiac arrest range from 0.2% to 23%, with a median of 6.4% in the United States. The majority of patients who survive an out of hospital cardiac arrest (OHCA) are resusucitated at the scene of the arrest. For those who cannot be immediately resuscitated, deciding whether to terminate resuscitation efforts […]
Hybrid approach to multi-vessel disease shows promise
Recent publications describing the excellent long-term results of minimally invasive coronary artery bypass grafting using the left internal mammary artery (LIMA) to supply the left anterior descending coronary artery (LAD) [ATS 2007;83:108-14], have raised interest for hybrid revascularisation procedures which involve minimally invasive CABG to LAD and stenting (PCI) of remaining lesions in coronary arteries […]
No additional benefit from thrombolysis during out-of-hospital cardiac arrest
Myocardial infarction and pulmonary embolism account for approximately 70% of out of hospital cardiac arrests. Cardiac arrest itself activates systemic coagulation hence thrombolytic therapy delivered during cardiopulmonary resuscitation can dissolve intravascular blood clots and has beneficial effects on microcirculatory reperfusion, improving survival and neurological recovery. […]
No benefit from irbesartan in patients with normal ejection fraction heart failure
The I-PRESERVE study (Irbesartan in Heart Failure with Preserved Ejection Fraction) assessed the efficacy of the angiotensin II receptor blocker (AIIRB) irebesartan on mortality and cardiovascular morbidity in patients with heart failure and a preserved LVEF. This was a multi-centre international trial which enrolled 4128 patients with a minimum age of 60 years and NYHA […]
Beta-blockers: all are equal, but some more than others
Carvedilol, Metoprolol and Bisoprolol have all been shown to improve outcomes in patients with heart failure. These evidence based beta-blockers (EBBB) are in contrast to atenolol, propranolol, and timolol, which have not been directly tested in heart failure. Therefore if a patient on one of these agents develops heart failure, is it neccesary to switch […]