For the first time a very large trial has shown that dual antiplatelet therapy (DAPT) improves cardiovascular outcomes when given to patients one to three years after a heart attack. Because it has been shown previously to reduce the high risk of recurrent events for up to a year following a heart attack, DAPT is considered to be standard therapy during this time period. But whether or not longer term treatment after a year would be also beneficial has been controversial.
AstraZeneca today announced that the Pegasus-TIMI 54 study had successfully reached its primary endpoint.
Click here to read the full post on Forbes.
Drug-eluting stents (DES) have been viewed as a great advance over earlier stents and balloon angioplasty because they result in many fewer cases of restenosis. But enthusiasm for the first generation of DES was somewhat curbed due to reports of late stent thrombosis (ST), a rare but very dangerous complication. Now findings from a large ongoing registry study provide some reassurance about the long-term safety of the new generation of drug-eluting stents in patients with heart attacks (STEMI). The results are published in the Journal of the American College of Cardiology.
SCAAR (Swedish Coronary Angiography and Angioplasty Registry) investigators analyzed data from 34,000 primary PCI patients who received a bare-metal stent, an old-generation DES, or a new-generation DES.
Click here to read the full post on Forbes.
A trial that started back in 1990 continues to demonstrate a significant mortality advantage for intensive insulin therapy in heart attack (MI) patients. But experts say the trial design is so outdated that the findings should have no influence on clinical practice today.
During the years 1990 through 1993 the Swedish DIGAMI I (Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infaction 1) trial randomized 620 MI patients with elevated glucose levels to either intensive insulin treatment or conventional therapy. Earlier results from the trial showed beneficial effects, including improved survival, for patients in the intensive treatment arm.
Now, a paper published in The Lancet Diabetes & Endocrinology, presents 20-year followup results showing an average 2.3 year increase in survival for patients in the treatment arm (median survival 7.0 years versus 4.7 years, HR 0.83, CI 0.70-0.98, p=0.27).
Click here to read the entire post on Forbes, including an extensive comment from Darren McGuire.
A great lesson in how not to report about heart attacks in the general media, from Gary Schwitzer, health journalism watchdog:
Journalists: don’t use the term “massive” heart attack if you don’t know what you’re talking about
… Very quickly, the term “massive heart attack” started going viral among Minnesota news organizations and on Twitter and Facebook.
Two and a half hours later, Rybak was tweeting from the hospital: “My cardiac surprise/Gave me quite a start/But it proves this politician/Has a great big heart.”
“His former spokesman, John Stiles, described the heart attack as “serious,’’ but said Rybak will be released in several days.”
“Massive heart attack” is a vague, frightening, dangerous term to be throwing around in the absence of evidence. I know how I reacted when I read the news yesterday; many other readers’ comments showed that they thought Rybak was dead or dying imminently.
Read the entire post at HealthNewsReview.Org.
Although primary PCI has emerged as the best treatment for STEMI, most patients don’t receive this treatment within the early time frame when it is known to be most beneficial. Delay in presentation is one important factor. Another is that most patients don’t arrive at a PCI-capable hospital and cannot be transferred fast enough to a PCI hospital.
The STREAM (Strategic Reperfusion Early after Myocardial Infarction) trial was planned as a proof-of-concept study to assess whether fibrinolysis was a beneficial alternative in this difficult group. Results were presented at the ACC in San Francisco and published simultaneously in the New England Journal of Medicine.
Click here to read the full story on Forbes.
Prior to Hurricane Katrina, heart attacks in New Orleans followed a well-known circadian and septadian (today’s word of the day, meaning day of the week) pattern, with predictable increases on Mondays and in the morning hours. Now a new study finds that the notorious 2005 hurricane dramatically altered that pattern for at least three years, shifting the pattern to a much greater than expected occurrence over nights and weekends.
Read my full story on Forbes.