theHeart.org - Acute Coronary Syndromes

Latest European and US STEMI guidelines compared and contrasted

Fri, 06 Nov 2009 17:15:26 EST

The latest recommendations for the treatment of ST-elevation MI issued by American cardiology associations and the European Society of Cardiology are compared and contrasted in a new paper.

VELETI in print: Plaque sealing of SVGs a strategy "ahead of its time"?

Wed, 04 Nov 2009 15:30:23 EST

The imaging study was the first to show that stenting a non-flow-limiting stenosis of an SVG may help slow or halt the accelerated atherosclerosis that takes place in these vessels. An accompanying editorial cautions that the study does little more than "infer a trend toward anatomic benefit."

CAC scoring plus SPECT provide long and short view of cardiac risk

Tue, 03 Nov 2009 17:00:51 EST

UPDATED // An 1126-patient trial shows that SPECT and CAC scoring imaging tests are independent and complementary predictors of short- and long-term cardiac risk, respectively.

US updates advice on perioperative beta-blocker use in noncardiac surgery

Tue, 03 Nov 2009 14:30:32 EST

A US update on the perioperative use of beta blockers for noncardiac surgery is, says the lead author, "similar" to recent European guidance on this issue.

Imaging study shows plaque regression with niacin vs placebo

Fri, 30 Oct 2009 16:00:00 EDT

Just weeks before ARBITER-HALTS�6 results come out at AHA 2009, an MRI study suggests that niacin is better than placebo in statin-treated patients with low HDL, at least for reducing carotid wall area. Experts say they'd also like to see insights into niacin effects on lipid-rich plaque volumes—the more commonly seen end point with MRI.

First trial of viral-derived protein agent shows promise as anti-inflammatory ACS therapy

Thu, 29 Oct 2009 11:45:16 EDT

Inflammatory responses contribute to coronary plaque rupture, thrombosis, and vascular occlusion. Some viruses have proteins that interfere with these inflammatory responses. Researchers have identified a viral-derived protein that may eventually be an anti-inflammatory treatment for coronary syndromes.

Sex differences in changing MI prevalence, mortality challenge conventional wisdom

Thu, 29 Oct 2009 10:30:28 EDT

Two well-known observational registries highlight such changes in women and men over a decade or more: Do women younger than 55 still have an advantage over men in the same age group?

Bariatric surgery fails to reduce risk of MI long term

Wed, 28 Oct 2009 14:30:14 EDT

After a median follow-up of 12 years, MI rates were essentially the same among those treated with surgery and those who received conventional care for weight loss.

Contrary to common belief, women feel same heart-attack symptoms as men

Tue, 27 Oct 2009 14:30:23 EDT

Women and men have the same rates of chest pain and other classic symptoms during ACS, although women are more likely to experience some other symptoms such as jaw and neck pain.

NRMI data raise more questions about PCI in nonsurgery centers

Mon, 26 Oct 2009 13:00:23 EDT

A new analysis of national registry data suggests that the superior outcomes of NSTEMI patients in hospitals with open-heart-surgery capabilities vs those without it are due to their size, procedure volume, and adherence to medication guidelines.

New MESA data: Pericardial fat a better predictor of CHD than BMI

Fri, 23 Oct 2009 17:00:00 EDT

Pericardial fat, which is found around the heart, predicts future CHD events and may even be a better predictor of these than conventional obesity measures, such as BMI and waist circumference, a new study of MESA participants shows.

Iloprost prevents contrast-induced nephropathy in high-risk patients undergoing coronary intervention

Wed, 21 Oct 2009 13:00:34 EDT

Intravenously administered iloprost, a prostacyclin analog, may help prevent contrast-induced nephropathy in patients with renal dysfunction undergoing coronary procedures, a new pilot study suggests.

ACE inhibitors of benefit in ischemic heart disease patients with preserved LV function

Mon, 19 Oct 2009 17:00:00 EDT

Patients with ischemic heart disease and preserved LV function on standard therapy will gain additional benefit from taking ACE inhibitors, a new review concludes. The same cannot be said for ARBs, a drug class for which the evidence is much weaker, but these are a good substitute in those who cannot tolerate ACE inhibitors, the authors say.

TYCOON: One year of dual-antiplatelet therapy with DES isn't enough

Mon, 19 Oct 2009 12:45:34 EDT

New results from an Italian registry reopen the question of how long drug-eluting stent recipients should stay on a dual antiplatelet regimen to prevent late thrombosis.

Transfusion in acute HF: No extra mortality risk

Mon, 19 Oct 2009 11:00:10 EDT

Blood transfusions for anemia in acute decompensated heart failure don't exacerbate outcomes, as may happen in some ACS cases, suggests a one-year experience of hospitals in Israel. On the contrary�.�.�.�

Smoking bans reduce the risk of acute coronary events: IOM report

Fri, 16 Oct 2009 16:00:09 EDT

IOM report confirms the cardiovascular benefit of implementing a ban on smoking in public places. The reduction in acute MI, anywhere from 6% to 47%, typically occurs quickly, often within 12 months of the ban.

Zero CAC score not 100% reassuring in those presenting to ER with chest pain

Fri, 16 Oct 2009 12:45:08 EDT

In those presenting to the ER with chest pain, a prior zero calcium score cannot completely rule out a coronary obstruction, a new analysis of the MESA study has shown. This is likely due to the presence of soft plaques not detected by calcium screening, the researchers say.

Racial background woefully underreported in CV trials

Thu, 15 Oct 2009 13:15:10 EDT

Two-thirds of the 156 trials considered by the AHA in preparing a recent guideline failed to even record the ethnic backgrounds of participants, a new study has found. The researchers call for the reporting of race/ethnicity to be mandatory in all clinical trials, and they suggest medical journals should enforce this policy.

Scripps starts routine genetic testing for clopidogrel responsiveness

Wed, 14 Oct 2009 11:00:05 EDT

Scripps Health has announced that it is now offering patients undergoing elective stenting a test for the gene variants associated with an inability to convert clopidogrel to its active metabolite so that antiplatelet therapy can be individualized.

Hopes build for natriuretic-peptide risk stratification before noncardiac surgery

Tue, 13 Oct 2009 10:00:10 EDT

Could a preoperative blood assay take the place of imaging studies or other more costly assessments of cardiovascular risk? A meta-analysis suggests yes. A massive randomized trial is looking into it now.

Target HbA1c levels still the subject of much debate, but tailored therapy should be the aim

Fri, 09 Oct 2009 16:45:25 EDT

Diabetologists are trying to tease out the best message to convey when it comes to target HbA_1c levels for primary-care physicians and other nonspecialists who might be treating patients with type 2 diabetes.

EULAR: CV risk management in inflammatory arthritis

Fri, 09 Oct 2009 11:45:12 EDT

The European League Against Rheumatism has issued 10 recommendations for cardiovascular risk management in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.

Coronary thrombosis�the culprit is not just plaque rupture

Thu, 08 Oct 2009 17:45:48 EDT

Clots derived from a different source—erosions of the arterial wall—may be an important cause of MI and sudden death, particularly in younger women, who may need a different approach to treatment, new research suggests.

New review confirms homocysteine lowering does not prevent CVD events

Thu, 08 Oct 2009 15:30:45 EDT

The latest review to look at the effects of homocysteine lowering with vitamin-B supplementation has come to much the same conclusions as most other studies and analyses in this field.

IRIS confirms: No survival gains from early post-MI primary-prevention ICDs

Wed, 07 Oct 2009 17:00:00 EDT

Defibrillators implanted within a month of acute MI may prevent sudden cardiac deaths, but they don't reduce overall mortality, according to a trial that supports current guidelines based primarily on the smaller 2004 trial DINAMIT.

Lupus anticoagulant a major risk factor for stroke and MI in young women

Wed, 07 Oct 2009 10:00:40 EDT

Results of the RATIO study suggest lupus anticoagulant, but not anticardiolipin or antiprothrombin antibodies, is associated with increased stroke risk and to a lesser extent MI.

Counseling and education fail to reduce prehospital delays in ACS

Tue, 06 Oct 2009 16:00:00 EDT

Even among patients with documented ischemic heart disease, an intensive program of education and counseling about the importance of seeking treatment quickly does not lead to reductions in prehospital delays or increased ambulance use among those experiencing the signs and symptoms of an ACS, a new study shows.

Hypoglycemia associated with increased risk of MI among US veterans with diabetes

Mon, 05 Oct 2009 13:45:19 EDT

Close attention should be paid to diabetes patients who experience an episode of hypoglycemia, because a new case-control study suggests a 65% increased risk of MI in the immediate two-week aftermath of such an event. Doctors should tailor diabetes therapies to minimize the risk of hypoglycemia occurring, say the researchers.

Stroke reduction with dronedarone shown in post hoc analysis

Fri, 02 Oct 2009 17:15:19 EDT

Investigators say that although the analysis raises the possibility that a drug with antiarrhythmic activity could reduce the risk of stroke, dronedarone is not a replacement for oral anticoagulant therapy or a treatment for stroke prevention.

New "principles" on authorship and COI from PhRMA get mixed response

Fri, 02 Oct 2009 12:00:10 EDT

The "Principles on Conduct of Clinical Trials and Communication of Clinical Trial Results" echo recent standards set by medical journal editors, but some observers say the document, which has no penalty component, lacks real teeth.

HORIZONS analysis: 600-mg clopidogrel load preferable in primary PCI

Thu, 01 Oct 2009 16:00:46 EDT

The higher dose was associated with a reduced rate of ischemic events without an increase in bleeding in patients with STEMI undergoing primary PCI.

Time to act: Cardiologists, diabetes docs, and psychiatrists urged to work together to tackle CVD in the mentally ill

Wed, 30 Sep 2009 14:00:04 EDT

Doctors from across the specialties of cardiology, diabetes, and psychiatry are being urged to collaborate to improve care for the mentally ill, who are more likely to die from cardiovascular disease than any other cause.

BCIS-1 trial: "Bailout" intra-aortic balloon pump beats elective use in low EF/high-risk patients

Tue, 29 Sep 2009 10:45:47 EDT

The study provides an important answer to a question that has divided some interventionalists. Those who "swear" by IABP use for all high-risk, low-EF patients should rethink their practice. In hypotensive patients and those with cardiogenic shock, IABPs play a key role.

Early statin therapy in ACS: What's the level of evidence?

Mon, 28 Sep 2009 17:00:00 EDT

The use of high-dose statin therapy early in the course of acute coronary syndrome currently has the highest possible (class IA) recommendation in US guidelines, but a group of experts argues that this is inaccurate based on current evidence. However, they stress, they are not saying statins should not be used in this indication.

CHARISMA Genomics Substudy links loss-of-function allele and bleeding

Mon, 28 Sep 2009 14:15:11 EDT

Patients who are homozygous for the CYP2C19*2 allele are at increased risk of ischemia but less likely to bleed. Routine genotyping for the variant still isn't recommended.

Reduced bleeding and comparable stent thrombosis with DES and bare-metal stents: HORIZONS-AMI at two years

Fri, 25 Sep 2009 17:55:17 EDT

Two-year data showed significant reductions in bleeding and cardiac mortality in patients treated with bivalirudin when compared with those treated with heparin plus a GP IIb/IIIa inhibitor. In the stent arm of the trial, researchers showed that stent thrombosis rates were equivalent between DES and bare-metal stents, although both rates were high, at 4.1%.

PLATO-Invasive: Impressive ticagrelor results mirror overall trial findings

Fri, 25 Sep 2009 17:30:21 EDT

The prespecified subset analysis helps clarify the performance of the drug in patients managed invasively, including adding new insights into its benefits over both the 300-mg and 600-mg loading doses of clopidogrel.

COMPARE: "Real-world" randomized trial favors Xience V over Taxus Libert�

Fri, 25 Sep 2009 08:30:19 EDT

COMPARE is the second of two large randomized controlled trials comparing a Taxus stent with Xience V to show a clear benefit of the newer stent.

COGENT: No CV events but significant GI benefits of PPI omeprazole

Thu, 24 Sep 2009 16:30:07 EDT

The randomized controlled trial results should put a stop to alarmist headlines about PPIs blunting efficacy of antiplatelet drugs, experts say. By withholding PPIs, physicians are doing more harm than good, the results suggest.

New Canadian lipid guidelines will recommend CRP testing for certain patients

Thu, 24 Sep 2009 13:45:07 EDT

New Canadian guidelines for the diagnosis and treatment of dyslipidemia and the prevention of cardiovascular disease will recommend the testing of hs-CRP for certain patients, most notably those at intermediate risk. However, the lead author stresses that the majority of patients will not require a CRP test and that recommending and promoting a healthy lifestyle must be the first port-of-call for doctors.

SIRTAX LATE: No differences in MACE for first-generation stents at five years

Thu, 24 Sep 2009 08:30:17 EDT

After one year, Cypher had lower rates of death, MI, or repeat PCIs than Taxus in the SIRTAX trial. But four years later, investigators say all differences between the two have disappeared, in part due to more late "catch-up" with the Cypher.

Should patients go directly to a PCI-capable hospital? Two studies, different results

Wed, 23 Sep 2009 10:45:51 EDT

One trial showed that despite a mean treatment delay of 67 minutes, STEMI patients undergoing primary PCI taken first to an emergency department before transfer had equivalent rates of major adverse cardiac events when compared with those who presented directly to a PCI facility. A smaller study showed that taking patients directly to the cardiac center resulted in significantly better survival when compared with patients who were transported to an emergency department.

Senators question Dr Martin Leon's financial links to industry

Tue, 22 Sep 2009 17:15:30 EDT

UPDATED // The letter, from Sens Herb Kohl and Charles Grassley, states that Leon did not fully disclose much of the money he has received from outside companies.

Enoxaparin cheaper than UFH in STEMI patients undergoing thrombolysis?

Tue, 22 Sep 2009 17:15:18 EDT

A new analysis of the EXTRACT-TIMI 25 trial concludes that enoxaparin is slightly cheaper in the long term than unfractionated heparin for STEMI patients undergoing thrombolysis. But there are questions as to why 30-day data and not one-year results were used to model long-term cost-effectiveness.

Mixed start to planned MARVEL trial of post-MI autologous skeletal-myoblast therapy

Tue, 22 Sep 2009 14:00:42 EDT

A pilot analysis suggests the cell therapy can improve functional capacity, but amiodarone may be needed to prevent ventricular arrhythmias; its investigators say they plan to switch gears on the remainder of the study.

Should left main PCI be a class IIa indication?

Tue, 22 Sep 2009 13:15:44 EDT

TCT 2009 kicked off with a discussion on revascularization strategies for left main PCI. Interventionalist Dr Paul Teirstein argues the data are sufficient for left main PCI to be a class IIa indication, upgrading it from the current class III recommendation, but surgeon Dr David Taggart says that CABG is still the preferred revascularization option in the majority of left main patients.

ENDEAVOR IV: Revascularization rates similar for Endeavor and Taxus at three years, with Endeavor "pulling ahead" for safety

Tue, 22 Sep 2009 09:45:47 EDT

Rates of cardiac death and MI actually statistically favor the Endeavor stent at three years, new data show. Stent thrombosis occurred just once after one year for Endeavor, as compared with 11 cases after the one-year mark in the Taxus-treated patients.

Flu vaccine may protect against MI

Mon, 21 Sep 2009 18:30:00 EDT

A protective effect was seen in patients with established cardiovascular disease. Whether vaccination is protective in people with no vascular disease is less clear, a new review suggests.

Smoking bans cut heart attacks by up to a quarter

Mon, 21 Sep 2009 17:00:00 EDT

A nationwide smoking ban in the US would prevent up to 150�000 new MIs every year, the authors of a new meta-analysis estimate. They show that similar bans in parts of the US and in other countries have reduced the incidence of MI by almost 20% and that the longer the ban is in place, the greater the benefits seem to be.

How to shave 10 years off your life: Have high cholesterol, be hypertensive, and smoke

Fri, 18 Sep 2009 15:30:13 EDT

Smoking, together with high cholesterol and blood pressure, can knock 10 years off life expectancy in middle-aged men, new UK research shows. If excessive weight and glucose intolerance are added in, the difference can be as much as 15 years, they add.

Coumarin derivatives affect clopidogrel action

Thu, 17 Sep 2009 12:00:47 EDT

Another interaction that may affect the response to clopidogrel has been reported, this time with the coumarin derivative phenprocoumon, an anticoagulant commonly used in Europe.

Cutting salt intake in US could save $50 billion a year

Thu, 17 Sep 2009 11:00:49 EDT

A new economic analysis concludes that regulations to reduce sodium content in processed foods and/or voluntary reductions in salt by companies could save up to $50 billion a year in healthcare costs in the US.

CAD hospitalizations decline, but HF admissions increase

Wed, 16 Sep 2009 15:15:04 EDT

Newly initiated statin therapy after ACS reduces plaque burden within six weeks

Tue, 15 Sep 2009 16:45:07 EDT

Initiating statin therapy following an acute coronary syndrome resulted in a significant reduction in coronary atheroma volume after just six weeks, showing that the lipid-lowering drugs act quickly on atherosclerotic plaques.

New ASCOT analysis: Beta blockers not beneficial in hypertensives with tachycardia

Tue, 15 Sep 2009 14:15:57 EDT

Pulse rate should not be the determinant of which drugs are used in hypertension, conclude the authors of a new subgroup analysis of the ASCOT trial.

Conflicts of interest affect best practices in both industry-funded and non-industry-funded trials

Tue, 15 Sep 2009 12:00:19 EDT

Clinicians and researchers need to be more aware before signing on to studies about what potential conflicts might arise with the sponsor and set the ground rules for such areas as access to data, manuscript preparation, and right to publish.

Omeprazole, but not pantoprazole, inhibits clopidogrel's platelet response

Tue, 15 Sep 2009 11:15:53 EDT

The use of omeprazole significantly reduced the antiplatelet activity of clopidogrel, even with a high maintenance dose of the drug, and other PPIs, such as pantoprazole, should be preferred in clopidogrel-treated patients, according to investigators.

Cardiovascular health of Americans is "at a crossroad"

Mon, 14 Sep 2009 16:00:00 EDT

The number of Americans who have a low cardiovascular risk-factor profile is decreasing, indicating that after two decades of improvement, progress appears to be reversing. The overriding driver of this phenomenon is excessive weight, say the researchers, which in turn contributes to hypertension and diabetes, itself a major contributor to heart disease.

Sponsorship of med-school textbooks in Denmark exposes vulnerable minds to commercial bias

Mon, 14 Sep 2009 11:45:00 EDT

Results of a new survey showed that a surprising 15% of textbooks had one or more drug or device sponsors and, in two cases, those sponsors had tried to influence the content of the textbooks.

Spin not uncommon in negative RCTs, study shows

Mon, 14 Sep 2009 11:30:00 EDT

French researchers who systematically quantified the prevalence of spin across 72 negative randomized controlled trials say half of the studies put a positive spin on the negative findings in the conclusion sections of the papers.

Nationwide smoking ban cuts incidence of acute coronary syndrome in nonsmokers

Mon, 14 Sep 2009 09:45:00 EDT

A smoking ban in public places throughout Iceland resulted in a 21% reduction in ACS among nonsmoking men.

Homocysteine lowering cuts mortality in early-onset CAD patients

Fri, 11 Sep 2009 12:00:04 EDT

A new Israeli study finds that treatment with folic acid/B vitamins long term did significantly reduce mortality, but only in those with elevated homocysteine levels at baseline.

Ghost authorship on the wane, but guest authorship still common

Fri, 11 Sep 2009 11:00:38 EDT

UPDATED // Compared with a 1996 survey by JAMA editors, a 2008 survey indicates that the practice of having ghost writers pen papers, then not appear as authors, is down to 8%, from 12% in 1996. The practice of inviting a prominent name to appear in the list of authors, without requiring that person to contribute to the research, has held steady at roughly 20%.

Unresolved depression doubles risk of mortality in post-MI patients

Thu, 10 Sep 2009 15:00:28 EDT

The latest findings from the SADHART study show that new-onset depression is just as deadly as recurrent depression in patients who have suffered an MI.

UK NICE recommends limited role for prasugrel

Tue, 08 Sep 2009 14:00:15 EDT

The UK agency that governs reimbursement advises that prasugrel can be used in those ACS patients undergoing PCI who have STEMI, who are diabetic, or who have had a stent thrombosis on clopidogrel.