Cardiology

Coronary revascularization trends in the US

In this national database analysis, CABG rates declined significantly from 2001 to 2008, with the median caseload per hospital declining by 28%, whereas PCI rates were unchanged (abstract)

New guidelines for NSTEMI from ACC

The American college of cardiology has updated its guidelines for the management of patients with USA/NSTEMI. The most salient updates are the addition of prasugrel as an option (versus clopidogrel) in those undergoing PCI; the use of IIb/IIIa agents only in those that are high risk (+troponin, DM, substantial ST depression) but not in those without these risk factors, on 2 anti-platelet agents, or those with a high risk of bleeding; extending dual anti-platelet therapy beyond 15 months in some patients with a drug eluting stent; and carefully hydrating/limiting contrast in those with renal dysfunction. The full guidelines can be found at (ACC site)

Outcomes of patients with peri-operative MI

In this analysis of the POISE trial, 5% of patients suffered a peri-operative MI. 3/4 of them occurred within 48 hours, and 2/3 did not have any symptoms. 30 day death was 12% (versus 2% in post-op patients without an MI). Post-op MI is still relatively common, often asymptomatic, and associated with high mortality. This may justify the use of EKG monitoring in high risk patients shortly after surgery (abstract)

CABG versus medical therapy for reduced EF

In this trial of patients with reduced ejection fraction (EF <35%) and anatomy amenable to CABG, they were randomized to CABG or medical therapy. Overall death was not significantly different between the groups, but those in medical therapy had significantly higher rates of cardiovascular death. CABG appears to be superior to medical therapy for reducing cardiovascular death (abstract)
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