This website is intended for UK healthcare professionals only Log in | Register

Latest articles

April 2017 Br J Cardiol 2017;24:(2) doi: http://doi.org/10.5837/bjc.2017.009 Online First

Does CTCA improve the diagnostic yield from conventional coronary angiography? A DGH experience

Colin Reid, Mark Tanner, Hatef Mansoubi, Conrad Murphy

Abstract
Our objective was to determine whether the development of a computed tomography coronary angiogram (CTCA) service has improved the yield of significant coronary artery disease (CAD) and subsequent referral for revascularisation following conventional invasive coronary angiography (ICA).

A retrospective audit comparing angiographic findings in a cohort of 2,094 patients investigated between 2007 and 2012 with findings from a cohort of 554 patients investigated in 2013 and 2014 during which time a CTCA service had been established. Cases included were those patients undergoing elective angiography for the assessment of possible coronary disease without any history of previous revascularisation.  

In the pre-CTCA and CTCA cohorts the rates of one-vessel, two-vessel, three-vessel and left main stem disease were 20% vs. 18%, 14% vs. 14%, 10% vs. 11%, 2% vs. 3%, respectively, with overall yield of obstructive CAD of 46% in both cohorts (p>0.05 for all groups).

In conclusion, the availability of a CTCA service has not had any significant effect on the diagnostic yield of ICA. We propose that, adherence to current guidelines, results in a potential underuse of CTCA in the investigation of suspected stable CAD because a sizeable proportion of patients undergoing ICA have non-significant disease.

| Full text

April 2017 Br J Cardiol 2017;24:(2) doi: 10.5837/bjc.2017.010 Online First

SGLT2 inhibitors

Emma Johns, Gerry McKay, Miles Fisher

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a novel insulin-independent therapy for type 2 diabetes mellitus (T2DM). By inhibiting renal glucose re-absorption, they improve glycaemic control and have beneficial effects on weight and blood pressure. Current guidance states that any new diabetes medication must be shown not to unacceptably increase cardiovascular risk. The landmark EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial demonstrated that treatment with the SGLT2 inhibitor empagliflozin compared with placebo showed a significant reduction in the risk of major cardiovascular end points and hospitalisation for heart failure for patients with T2DM and existing cardiovascular disease. A positive impact on several renal outcomes was also demonstrated in secondary analysis. These milestone results are set to have significant implications on prescribing practice in T2DM, with potential benefits for many patients with existing cardiovascular disease.  

| Full text

April 2017 Br J Cardiol 2017;24:(2) doi: 10.5837/bjc.2017.011 Online First

Recognition and management of posterior myocardial infarction: a retrospective cohort study

Leigh D White, Joshua Wall, Thomas M Melhuish, Ruan Vlok, Astin Lee

Abstract
Characteristic electrocardiogram (ECG) features of posterior myocardial infarction (PMI) do not include typical ST-segment elevation and, therefore, carries the risk of delayed diagnosis and management. The aim of this study was to investigate how well PMIs are recognised and whether a lack of recognition translates to a larger infarction. This was a retrospective cohort study of patients sourced from a cardiac catheterisation database. Based on ECG analysis, patients included in this study included those meeting PMI criteria and those meeting ST-elevation myocardial infarction (STEMI) criteria as the control group. Door-to-balloon times were used as an outcome measure for differences in recognition between PMIs and other STEMIs. Troponin was used as a surrogate marker to measure degree of myocardial damage. There were 14 patients meeting PMI criteria and 162 meeting STEMI criteria. PMI patients had significantly longer door-to-balloon times. There was no statistically significant difference between PMI and STEMI group initial troponins t(169)=1.05, p=0.30, or peak 24-hour troponins t(174)=–1.73, p=0.09. In conclusion, using door-to-balloon times as a marker for recognition, this study illustrated that patients suffering PMI experience delayed recognition and management compared with non-PMI STEMIs. This did not, however, result in a significantly larger size of infarction as shown by peak troponin levels.
| Full text

April 2017 Br J Cardiol 2017;24:(2) doi: 10.5837/bjc.2017.012 Online First

Dedicated side-branch stent: what could go wrong?

Usha Rao, Simon C Eccleshall

Abstract

Bifurcation lesions are complex, technically difficult, have a higher rate of adverse events and lower success rates. This has led to the introduction of dedicated bifurcation stents, generally deployed along with main-vessel stent. Cappella Sideguard® is a dedicated bifurcation stent for treatment of bifurcation lesions, which otherwise could be technically challenging and may have low success rates. We report a very interesting case that resulted in a unique complication following the use of a dedicated bifurcation stent.

| Full text

March 2017 Br J Cardiol 2017;24:11–12 doi: 10.5837/bjc.2017.005

Optimising BP measurement and treatment before elective surgery: taking the pressure off

Simon G Anderson, Nigel Beckett, Adam C Pichel, Terry McCormack

Abstract
Hypertension remains a significant burden on mortality and morbidity, contributing to increasing costs to healthcare provision globally. There is detailed evidence-based guidance on the diagnosis and treatment of hypertension in the community, however, during the peri-operative period for elective surgery, consideration of an elevated blood pressure remains a conundrum. This is a consequence of paucity of evidence, particularly around specific blood pressure cut-offs deemed to be clinically safe. Postponement of planned surgical procedures due to elevated blood pressure is a common reason to cancel necessary surgery. A sprint audit of 11 West London Hospitals with national audit data indicated that the number of cancellations was 1–3%, equating to approximately 100 cancellations per day in the UK.1 This suggests that approximately 39,730 patients per year may have had a cancellation of a surgical procedure owing to a finding of pre-operative hypertension.2 The Association of Anaesthetists of Great Britain and Ireland (AAGBI) together with the British Hypertension Society (BHS) recognise the need for a nationally agreed policy statement on how to deal with raised blood pressure in the pre-operative period and have jointly published guidelines titled: “The measurement of adult blood pressure and management of hypertension before elective surgery” in the journal Anaesthesia.2
| Full text
READ MORE

Latest news

MEETING REPORT Online First

News from ACC.17

April 25, 2017

MEETING REPORT Online First

News from the 9th BSH day for revalidation and training

April 25, 2017

MEETING REPORT Online First

News from the British Heart Valve Society

April 25, 2017

NEWS Online First

Anticoagulation news

March 21, 2017

IN BRIEF

In brief

March 1, 2017

READ MORE
Close

You are not logged in

You need to be a member to print this page.
Find out more about our membership benefits

Register Now Already a member? Login now
Close

You are not logged in

You need to be a member to download PDF's.
Find out more about our membership benefits

Register Now Already a member? Login now