In patients with severe left ventricular dysfunction, PCI is associated with significant morbidity and mortality, particularly if large amounts of viable myocardium are supplied by the diseased coronary arteries. Although observational studies have suggested that intra-aortic balloon pump (IABP) insertion may decrease patient risk in this setting, no previous randomised controlled trial has examined this […]
Latest articles
Targeting valvular heart disease
The prevalence of valvular heart disease, in particular stenotic aortic disease, increases with age and reaches 13% in individuals over the age of 75 years. Despite this the aetiology and molecular mechanisms remain unclear, although several lines of evidence have suggested that its pathogenesis shares similarities to atherosclerotic disease, namely infiltration of inflammatory cells and […]
Rosiglitazone linked to increased vascular events
In 2007 a meta-anlaysis of 42 randomised trials involving rosiglitazone found a 1.4 fold increase in the risk of acute myocardial infarction (AMI) compared with non-thiazolidinedione therapies. Subsequently, a metaanalysis of 19 pioglitazone trials found a significant reduction in a composite outcome of non-fatal AMI, stroke and all-cause mortality. Therefore, this study set out to […]
Self-monitoring of hypertension in primary practice
Despite substantial advances in lifestyle and pharmaceutical interventions, only half of people on treatment for hypertension have their blood pressure controlled to current recommended levels. Patient selfmanagement with self-titration (ie, adjustment) of antihypertensive drugs has previously only been tested on a small scale, therefore this study assessed whether self-management by people with poorly controlled hypertension […]
Next generation coronary stents go head to head
First generation drug eluting stents (DES) are now a decade old, and several second generation DES have now entered the market. The Xience V or Promus everolimus-eluting stent has been accruing impressive data to suggest improved outcomes for restenosis and major adverse cardiac events, coupled with significantly improved deliverability. The Endeavour zotarolimus eluting stent however […]
Meta-analysis outlines true risks of diabetes
Although diabetes mellitus is an established risk factor for coronary heart disease (CHD) and stroke, a number of questions remain. For example, to what extent is diabetes associated with fatal vs non-fatal myocardial infarction? How much of the effect of diabetes on vascular risk is due to the effect of diabetes on lipids and blood […]
No role for B12/Folate Post Myocardial Infarction
Homocysteine has been noted to be consistently higher in patients with occlusive vascular disease than in controls, and this difference is also seen prior to the onset of disease. Although previous large-scale randomised trials have failed to show any benefit from lowering homocysteine levels through the use of folic acid based supplements, the reasons for […]
Second generation everolimus stent raises the stakes
Drug eluting stents, generally coated with either paclitaxel or sirolimus, have revolutionised the practice of interventional cardiology, markedly reducing the incidence of restenosis and the need for repeat procedures. Nevertheless, restenosis still occurs and the slower re-epithelialisation associated with these stents mandates the prolonged use of dual antiplatelet therapy to avoid potentially catastrophic stent thrombosis. […]
Modern Trends in Myocardial Infarction
Heart disease, and in particular coronary heart disease, is the leading cause of death worldwide but rates have actually been declining since the 1950s likely due to reductions in smoking prevalence and the availability of effective treatments for hypertension. Consequently, rates of death from acute myocardial infarction (MI) have also been falling but there is […]
Little Change in Prognosis for Ventricular Septal Rupture
Ventricular septal rupture following myocardial infarction is a rare but potentially catastrophic complication. Current ACC and AHA guidelines recommend immediate operative intervention in patients with postinfarction ruptures, regardless of their clinical status, but surgical repair remains very challenging with reported in-hospital mortality being reported in the range of 20-60%. […]