Clinical Cardiology Alert – December 1, 2014
December 1, 2014
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Thienopyridine Pretreatment in Patients with Non-ST Elevation Acute Coronary Syndromes: Where’s the Evidence?
In their recent meta-analysis, Bellemain-Appaix and colleagues looked at thienopyridine (P2Y12 inhibitor) pretreatment in seven studies that included primarily NSTEACS patients, including four randomized, controlled trials and three registries. In the overall cohort, pretreatment did not reduce the risk of all-cause mortality or cardiovascular death. Major adverse cardiovascular events were reduced in the pretreatment group (odds ratio [OR], 0.84; 95% confidence interval [CI] 0.72 to 0.98; P = 0.02), but individual endpoints, such as myocardial infarction, were not significantly affected. Among the subset of patients who underwent percutaneous coronary intervention (PCI), which represented a minority of the total cohort, there was likewise no reduction in death or cardiovascular death, but pretreatment with P2Y12 inhibitors was associated only with a non-significant trend toward a reduction of major adverse cardiac events (MACE). Within the PCI group, pretreatment was associated with a reduction of urgent revascularization (OR, 0.72; 95% CI, 0.52 to 1.00); however, this result was driven primarily by the results of the PCI subset of the CURE, in which the delay from admission to revascularization averaged a relatively long 10 days.
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FFR in Coronary Lesion Assessment: When is Negative Truly Negative?
Fractional flow reserve (FFR) is an invasive technique for determination of the physiologic significance of an intermediate coronary lesion. Multiple studies have demonstrated the ability of FFR to guide revascularization decisions. -
The Value of Family History in CAD
Although a routine part of the patient’s medical history, little is known about the value of family history in predicting coronary artery disease (CAD) events in otherwise low-risk patients. -
Clinical Value of Handheld Echocardiography
Small handheld ultrasound units are being deployed in emergency departments and other sites to aide in point-of-care cardiac diagnosis. -
Value of ECG LVH in Aortic Stenosis
Progressive, compensatory left ventricular hypertrophy (LVH) in aortic stenosis (AS) ultimately leads to myocardial injury, fibrosis, and LV dysfunction.