The anatomical SYNTAX score is advocated in both US and European guidelines to help establish the best revascularisation approach in patients with complex coronary artery disease. The purpose of this study was to improve the SYNTAX score further by including prognostically important clinical variables, as opposed to the anatomical variables that are used for the […]
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Weight gain, smoking cessation, and cardiovascular risk
It is known that smoking cessation substantially reduces the risk of cardiovascular disease (CVD), but does any subsequent weight gain attenuate the benefits of quitting smoking? The goal of this study was to answer this question in adults with and without diabetes. Specifically, the authors tested the hypothesis that quitting smoking decreases CVD risk compared […]
Ramipril improves symptoms of intermittent claudication
Approximately a third of patients with peripheral arterial disease (PAD) will develop intermittent claudication. A previous pilot trial found that the angiotensin-converting enzyme inhibitor ramipril is associated with increased pain-free and maximum walking times, contrasting with previous ACE inhibitor studies which may have been limited by issues of small sample size, short intervention duration, and […]
Reducing blood transfusions after cardiac surgery: clinical and economic benefits
Following cardiac surgical operations, blood transfusions are associated with a host of complications, including nosocomial infections, immunosuppression, transfusion-related acute lung injury, decreased health-related quality of life, and reduced early and long-term survival. A number of guidelines now emphasise the importance of conservative transfusion strategies and in this study, Lapar et al examine the impact of […]
Aldo-DHF: spironolactone improves diastolic function
Heart failure with preserved ejection fraction (HF-PEF) accounts for more than 50% of heart failure cases. To date, medical therapy has failed to show improvements in diastolic dysfunction, cardiac remodelling, or cardiovascular outcomes. As mineralocorticoid receptor activation by aldosterone contributes to the pathophysiology of HF through several different mechanisms, the Aldosterone Receptor Blockade in Diastolic […]
Cinacalcet fails to improve cardiovascular outcomes in dialysis
The risk of cardiovascular death in patients with chronic kidney disease is increased by a factor of ten in comparison with the general population. While a host of factors including chronic inflammation, increased oxidative stress and endothelial dysfunction contribute to this risk, disorders of mineral metabolism, including secondary hyperparathyroidism, are thought to contribute by promoting […]
Novel ICD programming reduces mortality
The implantable cardioverter-defibrillator (ICD) has consistently demonstrated benefit in reducing sudden cardiac death in patients at high risk of ventricular arrhythmias, but inappropriate ICD activations are a common occurrence with potential adverse effects on patient well-being and increased costs for health services. Strategies to reduce the frequency of inappropriate device activation without reducing efficacy in […]
30-day readmission frequent for heart failure and MI
In the United States, 30-day risk standardised readmission rates for heart failure (HF), acute myocardial infarction (MI), and pneumonia are now publicly reported. In order to better facilitate interventions targetted at reducing readmission rates, Dharmarajan et al. investigated readmission diagnoses and timings among Medicare beneficiaries readmitted within 30 days after hospitalisation for HF, MI, or […]
Platelet function testing fails to improve outcomes after PCI
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. […]
Acute heart failure with deteriorating renal function: no role found for ultrafiltration
Deteriorating renal function in patients with heart failure is a common situation, affecting approximately a third of patients presenting with acute pulmonary oedema, and is associated with worse outcomes. Due to the potentially nephrotoxic nature of many heart failure therapies, renal failure leads to difficult treatment decisions regarding ongoing diuretic therapy. Few options yet exist […]