Cardiology

Despite contemporary management, patients with acute coronary syndrome (ACS) remain at risk of recurrent adverse cardiovascular events.

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

We performed a systematic review and meta-analysis of all clinical trials comparing routine invasive strategy with selective invasive strategy in patients with non–ST-segment elevation acute coronary syndrome. We did not find either strategy to offer an advantage over the other, even when we excluded trials that did not use coronary stents and glycoprotein IIb/IIIa inhibitors.

The British Medical Journal concluded that their research does "not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality."

Francis Spinale, MD, PhD, MUSC, discusses his research on new techniques for detecting heart remodeling in early heart failure.

From the FDA (Food and Drug Administration) a warning about heparin.

The benefits of intensive glycemic control appear to be confined to microvascular disease, with 3 randomized controlled clinical trials failing to demonstrate a macrovascular benefit with intensive glycemic control in patients with type 2 diabetes.

New research to be presented at the 20th Annual Transcatheter Cardiovascular Therapeutics scientific symposium.

Hypertension may well be the most important public health issue facing society today.

The Unofficial Apple Weblog reports on a new unapproved Apple iPhone application that will "monitor your heart rate."

The latest research from Dr. Costas Karageorghis's 20-year-old program shows that music can increase physical endurance.

The US House of Representatives voted last week to approve the Heart Disease Education, Analysis Research, and Treatment for Women Act, legislation.

The article by Schwartzman and Brener (page 33) has 4 important implications for the treatment of acute coronary syndrome (ACS) patients who are found to have multivessel coronary artery disease (CAD) during diagnostic coronary angiography.

Millions of people in the United States require chronic anticoagulation to prevent thromboembolism secondary to chronic atrial fibrillation (AF), pulmonary hypertension, mechanical valve replacements, and other prothrombotic conditions.

Percutaneous closure of the patent foramen ovale (PFO) can be accomplished within 15 minutes using only fl uoroscopy for guidance. Local anesthesia and femoral vein puncture in the groin with a 9 French catheter can achieve about a 90% complete closure rate when the Amplatzer® PFO Occluder is used. Complications are extremely rare and physical restrictions are unnecessary starting a couple of hours after the intervention. Aspirin and clopidogrel (Plavix) are typically prescribed for a few months after the procedure, and the therapy concludes with transesophageal echocardiography at follow-up approximately 6 months later.

Migraines, including those with aura, are common and generally benign, affecting between 10% and 15% of the population.

The AMIS (Acute Myocardial Infarction in Switzerland) Plus prospective cohort study compared treatment and in-hospital outcomes between men and women with acute coronary syndrome (N = 26,452) admitted to Swiss hospitals between 1997 and 2007. The study reached several important conclusions: women had different baseline characteristics than men at admission, were treated with different drug regimens, and were significantly less likely to undergo percutaneous coronary intervention. After adjusting for these differences, researchers found no significant difference in the rates of in-hospital mortality between men and women, except for women aged 51 to 60 years, who were more likely to die in-hospital.

More than 1 million percutaneous coronary interventions (PCIs) are performed annually in the United States.

Although multivessel coronary artery disease (CAD) is commonly encountered in patients with acute coronary syndrome (ACS), no randomized controlled trials have evaluated the effi cacy of singlevessel percutaneous coronary intervention (PCI) versus multivessel PCI.

We found that lower cholesterol levels in middle age predicted lower total mortality and better physical quality of life in old age after 39 years of follow-up. No difference was seen in the mental component of quality of life. These findings support current guidelines for cholesterol goals and show that a low risk-factor level in midlife can affect long-term mortality and morbidity, postpone physical disability, and improve quality of life in old age.

In their study, Strandberg and Strandberg (page 13) found that during a 39-year follow-up of initially healthy men, aged 30 to 45 years (mean, 38 years), low serum cholesterol levels predicted better survival, better physical function, and better quality of life in old age, without adversely affecting mental functioning.

We analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.

It is difficult to make generalizations about treatment of elderly diabetic patients with coronary artery disease (CAD).