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…
Surviving A Heart Attack: Location And Time Make A Big Difference
January 22, 2014 by Leave a Comment
Stents Lose In Comparisons With Surgery And Medical Therapy
December 3, 2013 by Leave a Comment
Despite the enormous increase in the use of stents in recent decades, there is little or no good evidence comparing their use to the alternatives of CABG surgery or optimal medical therapy in patients also eligible for these strategies. Now two new meta-analyses published in JAMA Internal Medicine provide new evidence that the alternatives to PCI remain attractive…
Little Difference In Chest Pain Between Men And Women
November 26, 2013 by 1 Comment
In recent years the medical community has grown increasingly concerned that women with heart attacks may be less likely to receive prompt and effective treatment. The difference between the sexes in the presentation of symptoms is thought to be a major barrier to better treatment for women. But now a new study published in JAMA Internal Medicine finds…
FDA Removes Restrictions On Avandia
November 25, 2013 by Leave a Comment
In a remarkable climax to a long-running drama, the FDA today lifted major restrictions on rosiglitazone (Avandia, GlaxoSmithKline). The drug has been the subject of intense criticism and controversy since the 2007 publication of the famous Nissen meta-analsysis that first raised the possibility that the blockbuster diabetes drug might increase the risk of heart attack and cardiovascular death. The FDA said…
Promising GSK Heart Drug Misses Primary Endpoint In 15,000 Patient Trial
November 12, 2013 by Leave a Comment
GlaxoSmithKline announced today that the first of two large pivotal phase 3 trials with a new drug, darapladib, had failed to meet its primary endpoint. Full results of the trial will be presented at a scientific meeting. The STABILITY trial (STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY) tested the effect of darapladib, an investigational Lp-PLA2 inhibitor,…
Should You Be Worried About The Treatment For Low-T?
November 5, 2013 by Leave a Comment
The ubiquitous ads ask: “Should I be worried about Low-T”? But now there’s a good chance there’s a more important question: “Should I be worried about the treatment for low-T?” A new study published in JAMA raises the distinct possibility that testosterone therapy may increase the risk of death, heart attack, and stroke. The findings are hardly definitive, but may raise…
EUROMAX Meets Primary Endpoint But Editorialist Raises Questions
October 30, 2013 by Leave a Comment
When started during transport to the hospital during a heart attack, bivalirudin (Angiox, Medicines Company) improves clinical outcomes and reduces major bleeding, though at the cost of a small but significant risk in stent thrombosis. The results of the European Ambulance Acute Coronary Syndrome (ACS) Angiography) Trial (EUROMAX) were presented today by Phillippe Gabriel Steg…
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…
Pretreatment with Prasugrel Not Indicated in NSTEMI
September 1, 2013 by Leave a Comment
Although current guidelines strongly recommend that dual antiplatelet therapy be administered early in treating patients with non-ST-segment-elevation acute myocardial infarction (NSTEMI), it is unclear whether pretreatment is beneficial,especially with the newer, more potent and more rapidly acting antiplatelet agents prasugrel (Effient, Lilly) and ticagrelor (Brilinta, AstraZeneca). Now a large new study, ACCOAST, presented at the European Society of…
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…
Sex And The Cardiac Patient Should Not Be A Taboo Subject
July 29, 2013 by 3 Comments
It’s not an easy conversation to have. After a heart attack or other major cardiac event, talking about sex is awkward, and often avoided by patients, their partners, and physicians. But a new consensus statement from several major cardiology organizations urges physicians to get over their reluctance or embarrassment and counsel their cardiac patients about…
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…
Veterans Study Finds HIV To Be An Independent Risk Factor For MI
March 4, 2013 by Leave a Comment
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…
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…
Big Drop in Incidence and Fatality of MIs in England
January 26, 2012 by Leave a Comment
Since 2002 in England the incidence of acute MI has dropped by one-half and the case fatality rate by one-third, according to a new study published in BMJ. The overall decline in deaths from MI are about equally due to improvements in the prevention of MI and the treatment of MI. Kate Smolina and colleagues…
High STEMI Readmission Rate in US Linked to Shorter Hospital Stays
January 4, 2012 by Leave a Comment
STEMI (ST-segment elevation myocardial infarction) patients in the US are more likely to be readmitted to the hospital within 30 days compared to patients outside the US, but this difference loses significance when length of stay (LOS) is taken into account, according to a new study published in JAMA. Robb Cociol and colleagues analyzed data from 5,745 STEMI…
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