A new meta-analysis published in JAMA offers the best evidence yet that the flu vaccine may help prevent cardiovascular events. Jacob Udell and colleagues analyzed data from 5 published clinical trials in which 6,469 patients were randomized. People who received the flu vaccine had a significantly lower risk of cardiovascular events. The protective effect was largely restricted to…
Younger Women With Acute Coronary Syndromes Less Likely To Have Classic Chest Pain
September 17, 2013 by Leave a Comment
Younger women with an acute coronary syndrome are slightly less likely than men to present with the classic symptom of chest pain, according to a new study published in JAMA Internal Medicine. In recent years there has been a growing understanding that women with ACS are less likely to have chest pain and, partly as a result,…
Clear! CPR in the Hospital Is Not Always Good for the Patient
September 9, 2013 by Leave a Comment
On TV it always seems clear and simple. A patient in the hospital goes into cardiac arrest and the medical team springs into action. After a few tense moments of furious activity, and only after all seems lost, the patient is successfully revived. A few scenes later the smiling and now fully healthy patient thanks…
Too Much Emphasis on Door-to-Balloon Time?
September 4, 2013 by Leave a Comment
One of the great medical advances in recent years has been the improved treatment of acute myocardial infarction. As the enormous benefits of earlier reperfusion became evident, medical systems in many parts of the world aimed to treat increasing numbers of patients in a shorter time frame. The door-to-balloon (D2B) time as a performance measure…
New Test Could Speed Heart Attack Treatment In The Emergency Department
September 4, 2013 by Leave a Comment
Only 1 in 10 patients with acute chest pain in the emergency department turn out to have an actual heart attack (myocardial infarction), yet many are not released from the hospital until after 6-12 hours of cardiac monitoring and multiple ECG and troponin tests. The search for a test that can rule out MI early in…
A Disruptive TASTE of the Future? Getting the Best of Randomized Trials AND Observational Studies
September 1, 2013 by Leave a Comment
A new study from Scandanavia may influence the treatment of acute myocardial infarction. But it also may end up having a much bigger impact on the entire field of medicine by pointing the way to an entirely new way of performing randomized clinical trials rapidly and inexpensively. One expert said the trial design may represent…
American Heart Association Announces Late-Breaking Clinical Trials
August 27, 2013 by Leave a Comment
There are still a few days left in August and the European Society of Cardiology meeting doesn’t start until this weekend in Amsterdam. Nevertheless, the American Heart Association has released the list of late-breaking clinical trials for the annual meeting in November. Late-Breaking Clinical Trials 1: Acute Cardiovascular and Cerebrovascular Care Sunday, Nov 17, 2013, 4:00 PM –…
FDA Turns Back New Indication For Rivaroxaban To Prevent Stent Thrombosis In ACS Patients
June 28, 2013 by Leave a Comment
Johnson & Johnson said today that it had received a complete response letter from the FDA for the supplemental new drug application for rivaroxaban (Xarrelto) for the prevention of stent thrombosis in patients with acute coronary syndromes (ACS). Earlier this year the FDA turned down for the second time the sNDA for the general use of rivaroxaban to…
Some Patients With Minor Stroke Or TIA May Benefit From Early Clopidogrel And Aspirin
June 26, 2013 by Leave a Comment
Some people with minor ischemic stroke or transit ischemic attack (TIA) may benefit from dual antiplatelet therapy with aspirin and clopidogrel, according to a large new study from China published in the New England Journal of Medicine. In the immediate period following a TIA or minor stroke people are at high risk for having a major stroke. Aspirin…
Rivaroxaban Gains Approval In Europe For ACS Indication
May 24, 2013 by Leave a Comment
Rivaroxaban (Xarelto, Bayer) has been approved in Europe for the prevention of atherothrombotic events (cardiovascular death, myocardial infarction or stroke) following an acute coronary syndrome (ACS). The drug was approved at a dose of 2.5 mg twice-daily and should be used in combination with standard antiplatelet therapy. Rivaroxaban is now the only oral anticoagulant to receive an…
Instagram for Heart Attacks: iPhone App Speeds ECG Transmission To Hospital
May 17, 2013 by Leave a Comment
In the crucial early stages of a possible heart attack, EMTs on the scene now rely on slow and unreliable proprietary technology to transmit vital ECG data to physicians at a hospital for evaluation. But a new iPhone app using standard cell phone networks may help speed the process and, ultimately, cut delays in treatment…
Eplerenone May Help Prevent Heart Failure In Acute STEMI Patients
March 10, 2013 by Leave a Comment
A new trial presented at the ACC in San Francisco suggests that the mineralocorticoid receptor antagonist eplerenone Pfizer, Inspra) may help prevent the development of heart failure when given acutely in STEMI patients without preexisting heart failure. In the REMINDER trial 1,012 STEMI patients were randomized to eplerenone or placebo. After 10.5 months of followup, the primary endpoint–…
Fibrinolysis May Benefit Late-Arriving STEMI Patients
March 10, 2013 by Leave a Comment
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…
FDA Again Rejects ACS Indication for Rivaroxaban (Xarelto)
March 4, 2013 by Leave a Comment
For the second time the FDA has turned down the supplemental new drug application (NDA) for the proposed indication of rivaroxaban (Xarelto, Johnson & Johnson) to treat patients with acute coronary syndrome (ACS). … In a new press release issues on Monday afternoon, the company restated its confidence “in the robustness and results of the ATLAS…
Trials Of Niacin And Atrial Fibrillation Device Will Headline American College Of Cardiology Program
January 22, 2013 by Leave a Comment
Two big trials will highlight this year’s American College of Cardiology meeting in March in San Francisco. First is the PREVAIL trial testing Boston Scientific‘s long-anticipated Watchman left atrial appendage closure device for stroke prevention in patients with atrial fibrillation. Second is the detailed presentation of the controversial failed HPS2-THRIVE trial of extended-release niacin and laropiprant. Read my…
UK Politician Urges More Use Of Ticagrelor To Preserve AstraZeneca Jobs In UK
January 14, 2013 by 3 Comments
Use it or lose it. A UK politician is urging the National Health Service (NHS) to increase use of the antiplatelet drug ticagrelor (trade name Brilinta in the US, Brilique and Possia in the EU) in order to prevent the loss of British jobs. Like nearly all the major pharmaceutical companies, AstraZeneca has been fighting…
Timing Of Heart Attacks Shifted In New Orleans After Katrina
January 7, 2013 by 3 Comments
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,…
New Guidelines Define State-of-the-Art STEMI Care
December 17, 2012 by Leave a Comment
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…
Study Suggests Aspirin Resistance May Not Be Real
December 5, 2012 by 1 Comment
Is it resistance or pseudoresistance? According to a new study published in Circulation, aspirin resistance may be a myth, an artifact of the enteric coating of most aspirin tablets. The coating, which is designed to prevent gastrointestinal side effects caused by aspirin, may delay or conceal the effects of the drug, the study suggests, but the antiplatelet effects of…
PCI Utilization Lower In States With Public Reporting Of Outcomes
October 9, 2012 by Leave a Comment
In patients with acute MI, utilization of percutaneous coronary intervention (PCI) is lower in states that publicly report outcomes data, according to a new study published in JAMA. Despite the difference in utilization, however, there was no difference in mortality between reporting and nonreporting states. Karen Joynt and colleagues used Medicare data to analyze PCI utilization and mortality…
Registry Study Raises Questions About Cardioprotective Effect Of Beta Blockers
October 2, 2012 by 1 Comment
Although beta-blockers have been a cornerstone of therapy for patients with coronary artery disease for more than a generation, a new study published in JAMA suggests that that in the modern era beta blockers may not improve outcomes. Sriapl Bangalore and colleagues analyzed data from 44,708 patients enrolled in the Reduction of Atherothrombosis for Continued…
News Briefs: Cholesterol Trends, AHA Late-Breakers, FDA Updates On Rivaroxaban And Heartware HVAD
September 7, 2012 by Leave a Comment
Cholesterol Trends The Centers for Disease Control issued a new report with the latest details about the prevalence of cholesterol screening and high blood cholesterol in US adults. Here is their summary of the key findings: …cholesterol screening increased from 72.7% in 2005 to 76.0% in 2009, whereas the percentage of those screened who reported…
Unrecognized MI: More Prevalent And Dangerous Than Previously Suspected
September 5, 2012 by 2 Comments
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…
Danish Survey Finds Clopidogrel Less Effective In Diabetics
September 4, 2012 by Leave a Comment
A large nationwide survey of MI survivors in Denmark provides new information about the efficacy of antiplatelet therapy with clopdiogrel in patients with diabetes. In a paper published in JAMA, Charlotte Andersson reports on 58,851 MI patients, 12% of whom had diabetes and 60% of whom received clopidogrel. As expected, diabetics had a worse outcome than nondiabetics: the…
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