Platelet inhibition is central to the modern management of acute coronary syndromes, but up to one third of patients have a sub-optimal response to drug therapy. Bedside assays can determine the degree of platelet reactivity during treatment but it remains unclear whether the use of such testing to guide therapy leads to improved patient outcomes. […]
Category: Interventional cardiology
Bone marrow cells as therapy for ischaemic cardiomyopathy
Two trials in the Journal of the American Medical Association (JAMA) address the impact of bone marrow-derived cell therapy on safety and surrogate endpoints in patients with ventricular dysfunction due to ischaemic heart disease. […]
FREEDOM: CABG superior to PCI in diabetics
Diabetes is one of the principle aetiological factors for coronary artery disease with vascular disease in diabetics displaying a particularly aggressive phenotype, often resulting in multivessel disease. Current evidence suggests that CABG is particularly beneficial in these patients as compared with PCI. however, much of this evidence was either gathered in the era before modern […]
CETP inhibition fails to lower risk after ACS
The reduction of low-density lipoprotein (LDL) cholesterol levels has been consistently shown to lead to cardiovascular benefits, but whilst in observational analyses higher levels of high-density lipoprotein (HDL) are associated with a lower risk of coronary events, it remains uncertain whether raising HDL therapeutically reduces cardiovascular risk. One strategy to increase HDL is through inhibition […]
Public Reporting of PCI Outcomes
Public reporting of outcomes is designed to motivate clinicians to improve performance, and allow patients to choose high quality hospitals. However, it has also been proposed that these measures prevent physicians from undertaking high-risk cases. The purpose of this study was to determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower […]
FAME II: FFR guided PCI versus medical therapy
Whilst the role of PCI in the treatment of acute coronary syndromes is rarely debated these days, its use in patients with stable angina remains less certain, particularly since the COURAGE trial which failed to demonstrate a prognostic benefit when compared to optimal medical therapy. However, few patients in COURAGE had any functional assessment of […]
COMFORTABLE AMI: New-generation DES shows benefit
Drug-eluting stents (DES) with biodegradable polymers can allow controlled drug release followed by subsequent degradation of the polymer, leaving a in essence a bare-metal stent. In patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (STEMI), this may prevent the delayed vessel healing that is thought to be caused at least in […]
RAPID GENE shows utility of bedside genetic testing
The CYP2C19*2 allele is a common genetic variant that has been associated with a significantly increased risk of major cardiovascular events and stent thrombosis following percutaneous coronary intervention (PCI). In this study a novel point-of-care genetic test was used to identify carriers of the CYP2C19*2 allele and to tailor a pharmacogenetic appriach to dual antiplatelet […]
Glucose-Insulin-Potassium shows some benefit in acute coronary syndrome
Intravenous glucose-insulin-potassium (GIK) is postulated to be beneficial in acute ischaemic syndromes via two mechanisms: by providing metabolic support to ischaemic myocardium, and by preventing arrhythmias and cardiac arrest due to ischaemia-related metabolic derangements. Importantly, these benefits are most likely to be seen if GIK is started as soon as possible after the onset of […]
Quality improvement measures ameliorate ACS outcomes
While multiple randomised controlled trials have outlined the optimal care for patients with acute coronary syndromes (ACS), evidence-based therapies are not always applied, particularly in low- and middle-income countries. In this Brazilian study, the authors hypothesised that a multifaceted quality improvement (QI) intervention could improve the use of evidence-based therapies and improve ACS outcomes. […]