A Requiem for Routine Clot Removal During Heart Attacks

Using a stent to open a blocked coronary artery is the treatment of choice in the early period of a heart attack (myocardial infarction). A limitation is the risk of dislodging part of the clot, leading to new downstream blockages of smaller vessels. One strategy that has been under development for a long time is thrombectomy, in…

Click here to continue reading…

AstraZeneca Drug Improves Outcomes After Heart Attacks

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…

Click here to continue reading…

Counterintuitive Advice About Staying Alive After A Heart Attack

… An interventional cardiologist– the cardiologists who put in stents and usually treat heart attack patients in the first few hours– asked an electrophysiologist– the cardiologists who treat arrhythmias– whether wearable defibrillators should be used post-MI. Here’s what that electrophysiologist, Edward J. Schloss, the medical director of cardiac electrophysiology at Christ Hospital in Cincinnati, OH, replied….

Click here to continue reading…

Controversial Trial Finds No Benefit For Expensive Medicines Company Drug

Although there is broad consensus in the medical community that primary PCI is the best treatment for heart attack patients when it can be delivered promptly, there is no agreement about the best accompanying drug regimen, which usually entails a combination of antiplatelet and antithrombotic drugs. The role of one antithrombotic, bivalirudin (Angiomax, The Medicines Company) has…

Click here to continue reading…

Intensive Insulin Therapy Saves Lives– But Is The Finding Still Relevant?

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 But experts say the trial design is so outdated that the findings should have no influence on clinical practice today.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…

Click here to continue reading…

High-Sensitivity Troponin Test Could Identify Low Risk Chest Pain Patients In The ED

Approximately 15-20 million people in Europe and the United States go to the emergency department every year with chest pain. Many can be discharged early if they are not having an acute coronary syndrome. A large new single-center observational study, presented at the American College of Cardiology meeting in Washington, DC and published simultaneously in the Journal…

Click here to continue reading…

Surviving A Heart Attack: Location And Time Make A Big Difference

Two studies published this week offer fresh evidence that your life may depend on where and when you have a heart attack. 1. Heart attack patients in the United Kingdom are more likely to die than heart attack patients in Sweden, according to a study published in the Lancet. … 2. Heart attack patients are more likely to die…

Click here to continue reading…

Merck’s Vorapaxar Gets Positive FDA Review

A few years ago a novel antiplatelet agent from Merck seemed all but dead. Vorapaxar, a thrombin receptor antagonist, was widely thought to have no future after unacceptably high serious bleeding rates were found in two large clinical trials studying the drug in a wide variety of acute and chronic cardiovascular patients. But hopes for the drug resurfaced with…

Click here to continue reading…

Veterans Study Finds HIV To Be An Independent Risk Factor For MI

Although it has long been suspected that people with the HIV virus are at increased risk for cardiovascular (CV) disease, reliable data has not been available. Now a new study published online in JAMA Internal Medicine provides a much clearer picture of the relationship between CV disease and HIV. … In an accompanying editorial, Patrick Mallon writes…

Click here to continue reading…

Timing Of Heart Attacks Shifted In New Orleans After Katrina

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,…

Click here to continue reading…

New Guidelines Define State-of-the-Art STEMI Care

New guidelines published online today in Circulation and the Journal of the American College of Cardiology provide an efficient overview of the best treatments for STEMI patients. (Click here to download the PDFs of the full version (64 pages) or the executive summary  (27 pages) of the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.) “We’re looking to a future where more…

Click here to continue reading…

Expert Consensus Document Offers Advice On Troponin Tests

A newly published document provides practical advice on the use of the popular and potent troponin tests. The Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations was developed by the American College of Cardiology Foundation in collaboration with several other societies to help address the many complex issues raised by the introduction…

Click here to continue reading…

Unrecognized MI: More Prevalent And Dangerous Than Previously Suspected

Unrecognized myocardial infarction (UMI) is more prevalent, and is associated with a worse prognosis, than may be generally understood, according to a new study published in JAMA. Studying an elderly (67-93 years of age) population in Iceland, Erik Schelbert and colleagues used ECG and cardiac magnetic resonance (CMR) to detect UMI. CMR was more effective than…

Click here to continue reading…

Troponin Test May Allow Rapid MI Rule-Out in the Emergency Department

More than three-quarters of people with chest pain can be triaged within an hour of arrival at the emergency department with a novel strategy utilizing high-sensitivity cardiac troponin (hs-cTnT), according to a study from Switzerland published in the Archives of Internal Medicine. The strategy is promising, according to anaccompanying editorial, but much work remains before it can be implemented…

Click here to continue reading…

Pages: 1 2

Meta-Analysis Compares Drug-Eluting and Bare-Metal Stents for Primary Angioplasty

A new meta-analysis comparing drug-eluting stents (DES) and bare-metal stents (BMS) in patients with myocardial infarction has provoked opposing take-away messages from an author of the study and an editorialist. The authors emphasize the reduction in target-vessel revascularization (TVR) associated with DES, but the editorialist focuses on several potential DES weaknesses suggested by the study….

Click here to continue reading…

Metaanalysis: Air Pollutants Raise Short Term Risk of MI

Air pollution significantly raises the short-term seven-day risk of myocardial infarction (MI), according to a new metaanalysis published in JAMA. Hazrije Mustafic and colleagues analyzed data from 34 studies and found a significant increase in the relative risk (RR) of MI for all the main air pollutants except ozone: carbon monoxide: RR 1.048, CI 1.026-1.070 nitrogen…

Click here to continue reading…