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EARLY REVASCULARISATION COULD SUBSTANTIALY REDUCE DEATH WITHIN ONE YEAR OF HEART ATTACK (p 1805)
May 22, 2002Authors of a Swedish study in this week's issue of THE LANCET conclude that early revascularisation-the restoration of coronary artery blood flow with balloon angioplasty or stenting-could substantially improve survival within the first year after a severe heart attack.
Revascularisation is often not considered a priority in the days after a severe heart attack. Previous research investigating the effect of revascularisation on survival for people who have had acute coronary events has produced conflicting results. Ulf Stenestrand from the University Hospital of Linkoping, Sweden, and colleagues assessed the effect of revascularisation and death within one year in individuals who survived for at least two weeks after a serious heart attack.
The investigators compared the one-year mortality data for around 2500 people who had undergone early revascularisation with 19,300 patients not given early revascularisation. Deaths within a year were twice as frequent (5.2%) for patients given conservative treatment compared with those given early revascularisation (2.5%), irrespective of age, sex, baseline characteristics, previous disease, or treatment.
Ulf Stenestrand comments: "This is a Swedish registry study, but even when statistical compensation has been taken into account, there still remains a 50% reduction in the risk of dying within one year after a heart attack if early revascularisation is performed. There are two possible explanations for these new findings: first, that both bypass surgery and balloon angioplasty have better success rates todaythan in the past; second, that this study included patients that were at a higher risk, i.e. sicker patients, than in previous studies. The results of this study should help change the management of patients that have a heart attack towards earlier revascularisation." (Quote by e-mail; does not appear in published paper).
Lancet
Ulf Stenestrand comments: "This is a Swedish registry study, but even when statistical compensation has been taken into account, there still remains a 50% reduction in the risk of dying within one year after a heart attack if early revascularisation is performed. There are two possible explanations for these new findings: first, that both bypass surgery and balloon angioplasty have better success rates todaythan in the past; second, that this study included patients that were at a higher risk, i.e. sicker patients, than in previous studies. The results of this study should help change the management of patients that have a heart attack towards earlier revascularisation." (Quote by e-mail; does not appear in published paper).
Lancet
Angioplasty Current Events and Angioplasty News RSSYour Own Stem Cells Can Treat Heart Disease
The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk. The transplant subjects also experienced fewer deaths than those who didn't receive stem cells.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
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Lifestyle changes remain important in fighting peripheral arterial disease
Modifying the risk of peripheral arterial disease (or PAD)-with healthy lifestyle changes-remains vital to one's health, note researchers in a recent issue of the Journal of Vascular and Interventional Radiology.
Study questions need for routine intervention in patients with renovascular disease
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Stent for life initiative
Primary angioplasty (with stent implantation) is the most effective therapy for acute myocardial infarction (AMI), but it is not available to many patients, even though most European countries have sufficient resources (ie, catheterisation laboratories) for its wider use.
Otamixaban for the treatment of patients with non-ST-elevation acute coronary syndromes
Data from a phase II trial of an investigational intravenous drug designed to block the formation of blood clots shows potential to reduce the risk of death, a second heart attack, or other coronary complications compared with the current standard of care in patients presenting with acute coronary syndromes (heart attacks or unstable angina).
New strategies for reperfusion therapy
A new trial has begun in order to ascertain once and for all whether the best strategy for patients who cannot receive P-PCI is early fibrinolysis, together with mandated angiography.
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