Acute Coronary Syndrome

Clinical cardiology

Generic drugs in CVD: Just as effective as brand-name pills

5 COMMENTS - Dec 2, 2008 16:00 EST

Twenty years of research show that generic CVD drugs across nine classes are just as good as brand-name agents, yet editorials often boost superiority of brand-name agents. (Kesselheim AS et al. JAMA 2008; 300:2514-2526.)

Prevention

Rapid-response teams may not reduce hospital codes or mortality rate

1 COMMENT - Dec 2, 2008 16:00 EST

Specialized teams trained to recognize and respond to early signs of cardiopulmonary arrest, thereby preventing "code blues" before they happen, are popping up at hospitals around the US, but a new study suggests there may be no evidence to support their use. (Chan PS et al. JAMA 2008; 300:2506-2513.)

Lipid/Metabolic

New research reveals how binge drinking could drive atherosclerosis

Dec 2, 2008 13:30 EST

It's not just the amount of alcohol is drunk, but the way that it is drunk that is important when it comes to cardiovascular health. New research suggests a precise mechanism by which binge drinking might contribute to atherosclerosis. (Redmond EM et al. Atherosclerosis; published online before print October 18, 2008.)

Clinical cardiology

CORE 64 published as debate over trial progress, technology proliferation continues

1 COMMENT - Nov 26, 2008 17:00 EST

Investigators say CORE 64 shows that CT angiography can accurately identify the presence and severity of obstructive CAD in symptomatic patients but that it is not yet at the point where it can replace invasive coronary angiography. Others focus on the widespread use of CT tests, despite no randomized clinical-trial data supporting its use. (Miller JM et al. Redberg R and Walsh J. N Engl J Med 2008; 359:2324-2336, 2309-2310.)

Clinical cardiology

Periodontal disease associated with elevated levels of Lp-PLA₂

Nov 25, 2008 18:30 EST

The independent association between oral health and inflammation suggests that inflammation may be a factor in the relation between oral health and cardiovascular disease, report investigators. (Mochari H et al. Am J Cardiol 2008; 102:1509-1513.)

Clinical cardiology

Lack of exercise, other bad behaviors explain link between depression and CVD, study suggests

Nov 25, 2008 16:00 EST

Physical inactivity, smoking, and poor adherence to medication probably explain why people with depression are at higher risk of CV events, and not "fancy physiological mediators," investigators for the Heart and Soul Study say. (Whooley MA et al. JAMA 2008; 300:2379-2388.)

Dr JC Tardif

Acute Coronary Syndrome

New anti-inflammatory compound promising in ACS

1 COMMENT - Nov 24, 2008 13:30 EST

UPDATED WITH COMMENTARY // A new anti-inflammatory compound, VIA-2291, has shown promise in a phase 2 trial in patients with acute coronary syndrome. The results provide sufficient basis to move forward with additional studies of the drug, says the lead investigator, but another expert disagrees. (American Heart Association 2008 Scientific Sessions.)

Acute Coronary Syndrome

Lower-than-expected bleeding in CABG patients taking clopidogrel within five days preop

2 COMMENTS - Nov 24, 2008 11:30 EST

People who took clopidogrel within five days of their procedure were more likely to require red blood cell transfusions but no more likely to require reoperation for bleeding than people who had taken it more than five days beforehand, the study showed. One surgeon cautions this is not a "carte blanche" for clopidogrel. (Kim JHJ et al. Am Heart J 2008; 886-892.)

Acute Coronary Syndrome

ACC/AHA publishes new performance measures for STEMI patients

1 COMMENT - Nov 18, 2008 13:30 EST

Differing from guidelines, the new performance measures identify aspects of care with evidence so strong, such as prescribing a statin upon discharge or delivering reperfusion in a timely manner, that every patient should be receiving the same treatment. In other words, "If you're not doing things a certain way, then you're not providing the best care," says one expert. (Masoudi FA et al. Krumholz HM et al. J Am Coll Cardiol, Circulation; published online before print November 10, 2008.)

Clinical cardiology

ECGs add little when it comes to prognosis in those with chest pain

7 COMMENTS - Nov 18, 2008 12:45 EST

ECGs or exercise ECGs have little incremental value over and above clinical assessment for prognosis in patients with suspected angina, a new study has found. Hence, such tests should not be used to rule out future events in these patients, researchers say. (Sekhri N et al. BMJ; published online before print November 13, 2008.)

Interventional/Surgery

OCT imaging suggests low rates of uncovered/malapposed struts following DES for AMI

Nov 18, 2008 11:30 EST

An OCT study conducted in a subset of HORIZONS-AMI patients suggests that exposed and malapposed stent struts in the setting of AMI are more common with drug-eluting stents than with bare-metal stents but still relatively rare. (American Heart Association 2008 Scientific Sessions.)

Prevention

Cardiovascular effects of air pollution, even in the comfort of home

Nov 14, 2008 16:45 EST

Researchers who fitted study subjects with "air-pollution vests" to continuously monitor exposure to both indoor and outdoor air pollutants say that people are probably exposed to much higher levels of pollutants than community monitoring stations typically indicate and that this exposure affects both endothelial function and systolic blood pressure. (American Heart Association 2008 Scientific Sessions.)

Arrhythmia/EP

THINRS: Home INR monitoring as effective as clinic-based care

4 COMMENTS - Nov 13, 2008 13:30 EST

A randomized comparison shows weekly home monitoring is safe but did not reduce stroke, major bleeds, or death vs monthly clinic INR testing, as had been suggested by previous studies. (American Heart Association 2008 Scientific Sessions.)

Acute Coronary Syndrome

TIMACS: Early invasive management safe in non-ST-elevation ACS, improves outcomes in high-risk cases

Nov 11, 2008 09:00 EST

The findings appear to mandate early intervention in high-risk cases and to support the use of either an early or delayed strategy for patients considered at low to intermediate risk. (American Heart Association 2008 Scientific Sessions.)

Acute Coronary Syndrome

New factor Xa inhibitor rivaroxaban moves into phase 3 for ACS

Nov 10, 2008 14:15 EST

A phase 2 trial has demonstrated the feasibility of the novel oral factor Xa inhibitor rivaroxaban in patients with acute coronary syndromes already treated with aspirin and clopidogrel. A phase 3 study with the drug, beginning next month, will reveal whether the benefits outweigh the bleeding risks. (American Heart Association 2008 Scientific Sessions.)

Lipid/Metabolic

SEARCH me: Null trial "morphed" into positive meta-analysis

Nov 9, 2008 20:30 EST

The SEARCH trial showed no effect on major vascular events with either an intensive 80-mg dose of simvastatin compared with a 20-mg dose or with homocysteine lowering using folic acid and vitamin B₁₂. But the statin data fit with other trials in the field, showing a "clear picture" emerging when it comes to the more-vs-less data on statins, say the UK investigators. (American Heart Association 2008 Scientific Sessions.)

Prevention

Eliminating inequalities in CHD: Focus on classic risk factors

Nov 6, 2008 18:30 EST

Focusing on the classic risk factors for coronary heart disease and ensuring that best-practice interventions to reduce absolute risk are implemented across the board could largely eliminate socioeconomic differences in CHD deaths, a new British study predicts (Kivimäki M et al. Lancet 2008; 372:1648-1654.)

Acute Coronary Syndrome

New ranolazine indication in US allows first-line use in angina

4 COMMENTS - Nov 6, 2008 17:45 EST

Acute Coronary Syndrome

Registry: Cardiogenic shock rates plunge over decade thanks to PCI, statins

1 COMMENT - Nov 6, 2008 16:45 EST

The 75% drop in how often ACS patients develop shock during hospitalization accounted for almost all the difference in a Swiss registry study; the ranks of those presenting already in shock didn't change. (Jeger RV et al. Ann Intern Med 2008; 149:618-626.)

Acute Coronary Syndrome

Sudden cardiac death after MI has declined over the decades, but first 30 days and heart failure up risks

Nov 4, 2008 16:00 EST

Physicians and patients need to be aware that sudden death is more common during the first few weeks post-MI and that the development of heart failure, at any time, increases the risk of sudden death in MI survivors. (Adabag AS et al. JAMA 2008; 300:2022-2029.)

Heart failure

HF up in recent decades as MI deaths fall

Nov 4, 2008 11:45 EST

A decline in deaths from MI in recent decades appears to have been accompanied by an increase in the incidence of heart failure, according to a new analysis from the Framingham Heart Study. The likely explanation is that sicker patients, who would have died from MI in earlier years, are now surviving but going on to develop HF, say the researchers. (Velagaleti RS et al. Circulation; published online before print October 27, 2008.)

Acute Coronary Syndrome

Six-month TRANSFER-AMI data show persistent benefit

Oct 30, 2008 15:00 EDT

Investigators observed persistent trends toward a reduction in reinfarction and say that the data support the 30-day results that showed a benefit of PCI within six hours of fibrinolytic therapy in STEMI patients. (Canadian Cardiovascular Congress 2008.)

Acute Coronary Syndrome

Door-to-balloon times of less than 90 minutes possible

2 COMMENTS - Oct 30, 2008 14:30 EDT

A new Mayo Clinic protocol resulted in sustainable and durable improvements for four years. (American College of Emergency Physicians Scientific Assembly 2008,)

Acute Coronary Syndrome

ADD-IFI: Improved exercise tolerance with ivabradine in stable angina patients

1 COMMENT - Oct 29, 2008 17:00 EDT

Adding the novel heart-rate-reducing medication to atenolol 50 mg in patients with stable angina improved exercise duration compared with beta-blocker use alone. Ivabradine was also shown to be safe and well tolerated, report investigators. (Canadian Cardiovascular Congress 2008.)

Prevention

MIs linked to daylight saving time may also help explain MI spikes on Mondays

Oct 29, 2008 17:00 EDT

Rest easy for now: MI rates appear to increase in the spring but dip marginally with the end of DST in autumn, due likely to the extra hour of sleep. (Janszky et al. N Engl J Med 2008; 359:1966-1967.)

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