Still puzzling: Best care for the frail and elderly with coronary artery diseaseJuly 21, 2008DURHAM, N.C. - A new study from Duke University Medical Center finds that patients treated solely with medications after suffering from chest pain, heart attack or coronary artery disease are more likely to die during the first year following their initial hospitalization. "Patients managed medically without stenting or bypass surgery tend to be elderly and frail, and in some sense we feel they have been overlooked," says Matthew Roe, a cardiologist at Duke and the senior author of the study appearing in the August issue of the Journal of the American College of Cardiology: Cardiovascular Intervention. "We wanted to find out what clinical factors were funneling them into a medicine-only group and what happened to them, when compared to patients who received stents and bypass procedures." Roe led a team of researchers in examining a subset of 8,225 patients from a previous study (the SYNERGY trial) which compared the effects of two different anti-clotting drugs in heart patients. For the current study, researchers included only patients who had undergone cardiac catheterization and who had been found to have at least one significant blockage in a coronary artery. A majority of these patients (52 percent) underwent coronary stent implantation to open their arteries, while 32 percent were medically managed, and 16 percent underwent coronary bypass surgery. Investigators discovered that patients in the medical management group were more likely to be elderly women with low body weight, and more likely to have had peripheral artery disease, high blood pressure, diabetes or a history of stroke or a previous bypass surgery. Researchers found that with all else being equal, the risk of death was highest for the medically managed group and lowest for patients who underwent stenting. Death rates among medically managed patients increased rapidly during the first three months following release from the hospital, and stayed higher than those in the other two groups. At one year, the mortality rate among the medically managed group was 7.7 percent, 3.6 percent for patients who underwent stenting, and 6.2 percent among those who underwent bypass procedures. "It is important to know that the patients in the medically managed group had a higher death rate despite receiving most of the currently recommended medications for this condition from clinical practice guidelines," says Roe. "There are often very good reasons why stenting or bypass are not viable options for some patients. What this study tells us is that for these patients who are medically managed, we need to come up with better treatment approaches that lessen their risk of death." Roe says possible solutions may arise from a new trial that is just getting under way. The new study, called TRILOGY will compare clopidogrel (Plavix) with the experimental drug prasugrel, another anti-clotting agent, among elderly and frail medically-managed patients with chest pain and coronary artery disease. An earlier trial found that prasugrel was effective in reducing the risk of clotting, but it also brought about a higher risk of bleeding. The TRILOGY trial will compare the two drugs again, but will study a lower dose of prasugrel than in the earlier study. The Duke Clinical Research Institute will manage TRILOGY, which is expected to enroll approximately 10,000 patients in hundreds of hospitals world-wide. Duke University Medical Center |
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| Related Coronary Artery Disease Current Events and Coronary Artery Disease News Articles Multiple health concerns surface as winter, vitamin D deficiences arrive A string of recent discoveries about the multiple health benefits of vitamin D has renewed interest in this multi-purpose nutrient, increased awareness of the huge numbers of people who are deficient in it, spurred research and even led to an appreciation of it as "nature's antibiotic." 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. New study links vitamin D deficiency to cardiovascular disease and death While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease. Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing. Learning the risks for stroke - and taking action With this theme in mind, the European Society of Cardiology (ESC) emphasises that most of the risks for stroke are also the major risks for coronary heart disease - and thus the object of the ESC's far-reaching prevention programme. Obesity may hinder optimal control of blood pressure and cholesterol Obese patients taking medications to lower their blood pressure and cholesterol levels are less likely to reach recommended targets for these cardiovascular disease risk factors than their normal weight counterparts, according to new research presented at the 2009 Canadian Cardiovascular Congress hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada. South Asian Canadians failing to get exercise message Exercise is a wonderful way of boosting heart health, but it's proving to be a tough sell in Ontario South Asian communities, Dr. Milan Gupta told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. Calcium scans may be effective screening tool for heart disease A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death. New type of sirolimus-eluting stent demonstrates superior results A new type of sirolimus-eluting stent (SES) successfully showed significantly greater neointimal suppression than the paclitaxel-eluting stent (PES) with greater vessel wall integrity surrounding the stent, confirming the finding of superiority of the SES over the PES stent for the trial's primary endpoint of in-stent late loss. Comprehensive cardiac CT scan may give clearer picture of significant heart disease A team of researchers led by Massachusetts General Hospital (MGH) radiologists has developed a computed-tomography-based protocol that identifies both narrowing of coronary arteries and areas of myocardial ischemia - restricted blood flow to heart muscle tissue - giving a better indication of clinically significant coronary artery disease. More Coronary Artery Disease Current Events and Coronary Artery Disease News Articles |
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