Cardiology

Azithromycin associated with higher CV death

In this large Medicaid cohort, those who took azithromycin has almost 3 times the risk of death compared to those not taking an antibiotic, and 2.5 times the risk of death compared to those taking amoxicillin. Not only should this dissuade unnecessary antibiotic use, but should also caution the use of azithromycin in those with high CV risk (abstract)

False + STEMI rates

In this analysis of 2 primary PCI centers, the rate of false+ activation of the STEMI team was 36%. This over activation of STEMI teams are likely a result of public reporting of time to PCI. Reducing time to appropriate PCI, and avoiding unnecessary activations, is a difficult balancing act (abstract)

Meta-analysis of new oral anticoagulants compared to warfarin for Afib stroke prevention

This meta-analysis of 3 randomized trials of patients with Afib found the 3 new oral anticoagulants (dabigatran, apixaban, rivaroxaban) reduced stroke/embolism by 22% (RR 0.78, CI 0.67 to 0.92), hemorrhagic stroke by 55% (RR 0.45, CI 0.31 to 0.68), mortality by 12% (CI 0.82 to 0.95) and vascular mortality by 13% (RR 0.87, CI 0.77 to 0.98), compared to warfarin. Major and GI bleeding were not significantly different between the groups. This meta-analysis confirms early enthusiasm for these agents in preventing afib-associated stroke, although cost and lack of reliable antidotes will continue to raise concerns for using these agents in all patients (abstract)

More on varenicline and cardiac events

In this large meta-analysis of 22 randomized trials of former smokers, the risk of cardiovascular events on treatment or within 30 days of discontinuation were not significantly different between the varenicline groups (0.63%) and the placebo groups (0.47%) (abstract). This opposes a former meta-analysis which found higher cardiac event rates within a year of discontinuing varenicline compared to placebo (abstract). Although these disparate results generate controversy about whether or not there is a risk, if there is it appears to be small.

Warfarin or ASA for CHF

In this large randomized trial of patients with systolic CHF and normal sinus rhythm, those randomized to warfarin had lower rates of ischemic stroke (hazard ratio 0.52, CI 0.33 to 0.82), but higher rates of major bleeding (1.8 versus 0.9 events per 100 patient years), compared to ASA. The decision between warfarin and ASA in CHF patients with normal sinus rhythm should be based on risk of stroke and bleeding, without a one-size-fits-all approach (abstract)
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