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 […]
Latest articles
Benefits of beta-blockade in stable coronary disease may be overestimated
While the benefits of beta-blockade following myocardial infarction (MI) are well known, these benefits have been extrapolated to all patients with coronary artery disease (CAD), and even to high risk patients without coronary artery disease. However, beta-blockers also have a number of side effects and their tolerability is not ideal. Therefore, the objective of this […]
Does good glycaemic control benefit children after cardiac surgery?
The benefit of tight glycaemic control in the post-operative setting has come under increasing scrutiny of late. Initial small scale studies suggesting large clinical benefits have been followed by much larger multi-centre trials demonstrating neutral or even harmful effects of tight blood sugar control, with most investigators pointing towards the high occurrence of hypoglycaemia as […]
Biomarker screening in primary prevention
Risk prediction models are widely used in primary care to identify and initiate therapy in those at risk for future cardiovascular events. While conventional risk factors such as smoking and hypertension are reliably and robustly represented in these models, the value of newer emerging biomarkers such as C-reactive protein (CRP) and fibrinogen are of uncertain […]
Cardiac MRI detects myocardial infarction in asymptomatic patients
Unrecognised myocardial infarction (UMI) may be more prevalent than previously suspected. Although several population studies have described the prevalence of UMI based on ECG findings, this method has limited sensitivity. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement has been extensively validated for the detection of myocardial infarction. The aim of this study was […]
Vascular stem cells and atherosclerosis
The development of atherosclerotic diseases involves the proliferation and migration of a variety of cell types. It has been generally accepted that vascular smooth muscle cells in the arterial wall play a crucial role in this process through a process of ‘de-differentiation’ from a normal contractile phenotype to a proliferative and synthetic state that drives […]
Berlin heart beats ECMO for childhood heart failure
Heart failure is uncommon in children but carries a poor prognosis with 46% of children with severe systolic dysfunction dying or undergoing transplantation within five years. Survival among children after heart transplantation is 83% at 3 years, but the limited availability of donor hearts prolongs the waiting period, resulting in a high rate of death […]
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 […]
CT FFR – de facto?
In recent years invasive coronary angiography (ICA) has been supplemented by the measurement of fractional flow reserve (FFR) to determine whether a coronary stenosis impairs delivery of oxygen to the heart. However this technique has not previously been available through non-invasive methods. While the use of coronary computed tomography (CT) calcium scoring and angiography has […]
Novel risk markers – CT looks strong
The primary prevention of cardiovascular disease involves classifying individuals according to their global cardiovascular risk. However, those at intermediate risk represent a particular challenge; while some may require aggressive treatment, others may be best managed by lifestyle measures alone. Biomarkers that have shown promise in improving risk discrimination include carotid intima-media thickness (CIMT), coronary artery […]