Keeping you up to date on recent headlines in cardiovascular healthcare:
Fast release of data led to rapid changes in DES use ... E-mail, search engines, smart phones and other new technologies that can disseminate new medical information quickly led to an almost immediate change in clinical practice for drug-eluting stents (DES), according to a study reported in Circulation: Cardiovascular Quality and Outcomes. With the quick release of data, studies presented at medical conferences in the age of instant information can have an almost immediate impact on patient treatment, said Matthew Roe, MD, lead author of the study and associate professor of medicine at Duke University Medical Center and at the Duke Clinical Research Institute (Durham North Carolina). "We were interested in whether practice patterns changed after the presentation of these studies," he said. "That's indeed what we showed." Researchers examined data from two large patient registries that showed from January 2006 through September 2006 (before the data were released) about 90% of patients with a type of heart attack known as a non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary stent implantation received drug-eluting stents, which are coated with anti-proliferative drugs to prevent narrowings from recurring within the coronary arteries. In September 2006, a number of studies were presented at the European Society of Cardiology scientific sessions that found drug-coated stents were associated with a higher risk of late stent thrombosis, or blood clots in the artery treated with the stent, compared with bare metal stents, which were not coated with anti-proliferative drugs. By the end of March 2007, DES use fell to 67% and usage continued to drop to 58% by the beginning of 2008, Roe said.
Imaging technique could help fight vs. atherosclerosis ... A new chemical imaging technique could one day help in the fight against atherosclerosis, suggests research published in the August 2009 edition of the Journal of the Royal Society Interface. According to the Imperial College London, atherosclerosis is the disease underlying most heart attacks and strokes and is characterized by lesions in the arteries, made of fats, collagen and cells. The lesions cause artery walls to harden and thicken, which severely restricts the flow of blood around the body and they can also rupture, leading to heart attacks and strokes. According to the research, understanding the precise chemical composition of an individual's lesions is important because the ones with higher levels of a type of fat called cholesterol ester are more prone to rupture. The team behind the new imaging technique, which is known as Attenuated Total Reflection Fourier Transform Infrared Spectroscopic imaging (ATR-FTIR imaging), believe that with further refinement, it could become a useful tool for doctors wanting to assess a patient's lesions. For example, by combining fibre optic technology with ATR-FTIR imaging, the researchers believe doctors could carry out real-time inspections of patients with atherosclerosis, in order to assess the progress of the disease and establish which patients are at the greatest risk of complications. The ATR-FTIR imaging technology works by using infrared light to identify different chemical molecules, which are mapped by an array detector to create a 'chemical photograph.' The researchers say further studies need to be done before the ATR-FTIR imaging could be used for patient care.
CABG study links transfusions with infection ... A study of almost 25,000 coronary artery bypass graft (CABG) patients has shown that receiving blood from another person is associated with a two-fold increase in post-operative infection rates. The research, published in BMC Medicine, also found considerable hospital variation in transfusion practices. Mary Rogers, from the University of Michigan (Ann Arbor), led a team of researchers who carried out the study. "Clearly, blood transfusions are vital in the treatment of some conditions, such as life-threatening bleeding. However, over the past several decades a body of evidence has accumulated that indicates various adverse effects in patients who receive transfusions, particularly with exposure to allogeneic blood," Rogers said. The researchers sought to assess hospital variation in blood use and outcomes in cardiac surgery patients, to see if unnecessary blood transfusions may be putting the safety of some patients at risk. Overall, 30% of the variation in transfusion practices was found to be attributable to the hospital where the CABG was performed. "The safety of patients undergoing CABG will likely be improved if hospitals carefully review current guidelines on allogeneic blood transfusion, closely adhere to such guidelines, and institute interventions to reduce inappropriate use of blood transfusions in recipients of CABG," Rogers said.
Online diabetes tool aims to calculate risk ... The American Diabetes Association (ADA; Alexandria, Virginia) has launched My Health Advisor, an online tool that helps people understand their personal risk for developing Type 2 diabetes, heart disease and stroke. My Health Advisor is available at http://www.CheckUpAmerica.org/MHA. The online calculator takes into account a person's specific risk factors, such as family history and lifestyle choices, as well as other factors like access to health care, to determine their risk for developing diabetes, heart disease and stroke. According to the ADA, the calculator immediately reflects and readjusts a person's risk outcome based on small changes they make in their lives, such as losing 5 to 10 pounds, quitting smoking or taking a daily aspirin. The organization noted that unlike other online health calculators, My Health Advisor uses the "powerful and unique" health simulation program, Archimedes. Archimedes pulls together large amounts of clinical research data to make highly accurate predictions about a person's health risks, according to the ADA. The software creates a virtual reality in which all relevant factors that can impact a person's health in the real world match the factors in the simulated world. To further ensure accurate assessments, the results have been compared directly with real-life clinical trial results and have a "nearly perfect correlation" with the outcomes of actual patients, the ADA said.
Study shows ultrasound predicts heart risk after TIA ... Ultrasound can be used to determine a patient's heart risk after a transient ischemic attack (TIA), according to research published in BMC Medical Imaging. An evaluation of transcranial (TCD) and extracranial (ECD) Doppler ultrasonography has shown that both future stroke and future cardiovascular ischemic events can be predicted by abnormal findings. Cardiovascular disease is the major cause of death on long-term follow-up after a TIA. Dr. Holger Poppert from the Technische Universit t M nchen, Germany, worked with a team of researchers to evaluate the ability of ultrasound to predict the likelihood of new vascular events in 176 TIA patients, with a median follow-up of 27 months. "Nearly 40% of the patients with either stenoocclusive disease in ECD or pathological findings in TCD suffered a new ischemic stroke or TIA. Furthermore, detection of reactive collateral flow patterns or intracranial stenosis by TCD predicts new cardiovascular ischemic events on medium to long-term follow-up," Poppert said. The team found that 5 of 18 patients with abnormal TCD findings (27.8%), but only 4 of 134 patients without (3%), developed a subsequent cardiovascular ischemic event. "Our findings support the routine use of TCD in addition to ECD in TIA patients," Poppert said. "Moreover, routine screening tests for coronary artery disease and aggressive prevention therapies should be considered in TIA patients with pathological TCD findings."
— Compiled by Amanda Pedersen, MDD