The current thrombolysis guidelines for acute ischaemic stroke recommend thrombolysis with alteplase initiated within 3 hours of symptom onset. This was following the landmark findings of the 1995 National Institute of Neurological Disorders and Stroke (NINDS) study group. The ECAS III trial (European Cooperative Acute Stroke Study), a multi-centre, randomised, placebo controlled phase 3 trial […]
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SEAS apart: no role for lipid lowering in aortic valve disease
Calcific aortic stenosis shares risk factors with coronary heart disease and predicts death and MI without the need for large gradients. Hyperlipidaemia has been suggested as a risk factor for the development of aortic stenosis but to date lipid lowering studies have demonstrated conflicting results. […]
DES show mortality benefit in AMI
Currently both bare metal stents (BMS) and drug-eluting stents (DES) are used during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). PCI has been demonstrated to reduce the rate of death or recurrent ischaemia when compared to medical therapy. To date trials comparing DES and BMS in acute MI have been limited by small […]
Longer antiplatelet therapy gives good DES outcomes
Recently an excess of acute adverse coronary events has been reported among diabetic patients treated with drug eluting coronary stents (DES) who received short-term (<6 months) dual antiplatelet therapy (Circulation 2007;115:1440-55). […]
ARIA suggests diagnostic angiography underused
Deciding which patients presenting with chest pain should undergo diagnostic coronary angiography (DCA) is an everyday dilemma for the cardiologist. In the ARIA (Appropriateness of Referral and Invesigation of Angina) study, Hemingway and colleagues used scoring criteria, based on patient-specific characteristics and validated by 2 panels of experts made up of 22 UK physicians, in […]
Alda-1 can protect against ischaemic damage
The discovery of the protective effects of myocardial preconditioning has stimulated much research into the molecular mechanism of this phenomenon. A number of cardiac proteins have been found whose levels or state of phosphorylation change with cardioprotection, but do any of these play a critical role? […]
Plastics additive linked to cardiovascular disease
Bisphenol A (BPA) is the base chemical used to make several plastic containers, cans and dental sealants. Evidence from animal studies has suggested several potential biological effects of BPA, including estrogenic activity, liver damage, thyroid hormone dysfunction, and obesity-promotion. […]
Metabolic assays of ischaemia show early promise
Metabolic technologies allow the profiling of low-molecular weight biochemicals such as amino acids, sugars, and lipids that are substrates and products in important biological processes, such as ischaemia. To examine whether this techology could be used to allow earlier detection of myocardial ischaemia and infarction, Lewis et al. applied mass spectrometry-based metabolite profiling to 36 […]
Bicuspid aortic valves – increased morbidity but not mortality
Bicuspid aortic valve is the commonest congenital cardiac abnormality in the adult population. Previous pathological studies have outlined aortic valve dysfunction, endocarditis, and even aortic dissection as potential causes of increased morbidity in this patient group. The purpose of this study was to observe the disease progression and cardiac outcomes of a large contemporary adult […]
BEAUTIFUL – no go for go slow with ivabradine
Ivabradine is a pure heart-rate lowering agent that is a specific inhibitor of the If current in the sino-atrial node; currently it is licenced for the treatment of angina. The BEAUTIFUL (morbidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricUlar dysfunction) trial aimed to determine if heart rate lowering with […]