The Harmonising Outcomes with Revascularisation and Stents in Acute Myocardial Infarction (HORIZONS-AMI) was a prospective open label, multi-centre controlled trial involving patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). It incorporated two factorial randomised phases to allow a comparison of the direct thrombin inhibitor bivalirudin alone with heparin plus glycoprotein IIb-IIIa […]
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Normalisation of blood glucose levels following myocardial infarction predicts favourable in hospital outcome.
Despite a strong association between elevated blood glucose levels and increased rates of mortality among patients hospitalised with acute myocardial infarction (AMI), the benefit of acutely lowering levels of blood glucose remains controversial. Several questions remain unanswered: […]
Clopidogrel and Asprin ACTIVEly prevent stroke
The ACTIVE Trial (Atrial Fibrillation Clopidogrel Trial with Irbesartan for the Prevention of Vascular Events) was designed to assess the role of clopidogrel and aspirin in the prevention of stroke and other vascular events in patients with atrial fibrillation (AF). ACTIVE W has already reported and compared clopidogrel + aspirin with a vitamin K antagonist. […]
Intramyocardial bone marrow cell injection improves myocardial perfusion
Animal studies have suggested that bone marrow cell injection can improve myocardial perfusion and improve ventricular function in chronic ischaemia, but the two randomized trials performed to date in humans have yielded conflicting results. […]
Angiotensin receptor blockers and atrial fibrillation
The recurrence of atrial fibrillation (AF) after cardioversion may be partially related to a process known as remodeling – the electrical, mechanical and structural properties of the atrial tissue are altered in a progressive and irreversible manner resulting in a more favourable substrate for AF. From animal models, blockade of the rennin-angiotensin-aldosterone system (RAAS) has […]
ICD implant risks highlight increasing sub-specialisation
Should cardiologists who are not electrophysiologists be inserting implantable cardioverter-defibrillators (ICDs)? Curtis et al. performed a retrospective cohort study of patients who had an ICD fitted between January 2006 and June 2007. Patients were grouped according to whom had implanted their device: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. The main outcome measures examined […]
No benefit from screening asymptomatic type 2 diabetics for CAD
Should patients with type 2 diabetes be screened for coronary artery disease if asymptomatic? In the DIAD study (Detection of Ischemia in Asymptomatic Diabetics), 1123 patients with type 2 diabetes and no symptoms of coronary artery disease (CAD) were randomly assigned to be screened with adenosine-stress myocardial perfusion imaging (MPI) or to no screening. The […]
Polypill pushes on
It has been calculated that a polypill containing asprin, a beta-blocker, a statin and an angotensin-converting enzyme inhibitor could reduce cardiovascular events in people with cardiovascular disease by about 75%. It has further been suggested that the addition of folic acid, and the use of three separate agents to lower blood pressure (each in low […]
Surgical ventricular reconstruction for heart failure
Surgical ventricular reconstruction is a technique which has been developed to reconstruct dysfunctional myocardial segments; it is usually performed in conjunction with coronary artery bypass grafting (CABG). Previous studies of this technique have not been randomised and have been limited to observational studies. […]
Depression worsens outcomes in heart failure
Depressive symptoms are prominent in elderly hospitalized patients with heart failure and have been associated with decreased functional status, increased hospital readmissions and greater mortality. However, little is known about the characteristics of heart failure patients prone to depression and their treatment. […]