Drug eluting stents have reduced restenosis rates, and the need for further revascularisation after stenting, despite initial concerns over late stent thrombosis. This complication has been attributed to chronic inflammation and neoatherosclerosis induced by the durable polymers used in these stents. Biodegradable stents have been hypothesised to reduce this inflammatory burden, by degrading to leave […]
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Cardiac arrest in marathon runners investigated
Despite the increasingly sedentary nature of society, one participation sport that is thriving is long-distance running with approximately 2 million people participating in marathon or half-marathons in the United States annually. Tragically, this increase in participants has led to an increase in reports of race-related cardiac arrests and in this study by Kim et al […]
Subclinical AF significantly increases stroke risk
Approximately 25% of all strokes are of unknown cause, and it has long been hypothesised that short subclinical episodes of atrial fibrillation (AF) may be an important common etiologic factor. While several studies have attempted to detect episodes of subclinical AF, most have been hampered by the infrequency of such episodes and the unlikelihood of […]
Hybrid revascularisation moves forward
Use of the left internal mammary artery (LIMA) in coronary artery bypass (CABG) procedures has led to 10 year patency rates approaching 90%, far surpassing rates for other graft types or for stents implanted percutaneously. Anastomosed to the left anterior descending artery, the LIMA provides reassuring protection in this critical territory, however it generally involves […]
Changing trends in AMI
Large series from around the Western world have consistently shown falling mortality and morbidity from cardiovascular disease but less information is available about age- and sex-specific outcomes and their changes in the recent past. […]
Early diagnosis of MI using serial troponin measurements
The recent introduction of high sensitivity troponin assays (hsT) has improved the sensitivity of this assay for the detection of myocardial infarction, whilst simultaneously decreasing specificity. To overcome this problem, the use of troponin kinetics – to identify acute myocardial damage – has been proposed, either alone or in combination with other diagnostic markers of […]
Vorapaxar fails to improve outcomes
Thrombin is a key component in the coagulation cascade, cleaving fibrinogen to form insoluble fibrin, and also acting as a potent platelet activator through its action on protease activated receptors. In the TRACER study the efficacy of the oral PAR-1 antagonist vorapaxar was assessed in patients presenting with non-ST elevation acute coronary syndromes. […]
SATURN shows plaque statin benefit
Statins have revolutionized the treatment of cardiovascular disease and have repeatedly demonstrated their ability to reduce adverse cardiovascular outcomes. However despite tantalizing data from some trials suggesting statins may even be capable of causing disease regression, few studies have formally assessed the comparative ability of competing drugs to achieve this. […]
AIM-HIGH fails to fly
Despite the efficacy of statins in reducing the risk of cardiovascular disease a substantial number of patients go on to have further events, even when LDL cholesterol targets are achieved. Consequently, interest has grown in combination therapy approaches and the HDL raising treatment niacin – a drug now over 50 years old – has enjoyed […]
Genetic factors related to early stent thrombosis
Dual anti-platelet therapy (DAPT) reduces cardiovascular events after PCI by more than 80%. However, stent thrombosis can occur in 0.5% to 4% of patients within the first year following PCI, with the majority occurring in the first month. Cayla et al. performed a case-control study using a candidate gene approach – looking in particular at […]