Tag Archives: percutaneous coronary intervention

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the

Dear Sirs, Research on sex difference in mortality after myocardial infarction (MI) since the 1990s has been debated and increased. Several observational studies have shown that younger women, in particular, seemed to have higher mortality rates than men of similar age during the two-year or longer follow-up, although these studies were mainly from the USA.1-3 Recent American studies have also found that, even after full adjustment for potential risk factors, excess risk for in-hospital mortality for women was still noted, particularly among those <50 years old with acute ST-segment elevation MI, leading to 98% (odds ratio [OR] 1.98, 95% c

The study The research is presented as a retrospective case-control study in the modern era of coronary intervention, and gives some insight into current practice. Data from 100 randomly selected patients aged over 80 years and a control group aged below 70 years were taken from a district general hospital (DGH) DCA database. This method of patient selection is perhaps the major weakness of the study. There will inevitably have been a high degree of case selection – particularly of older patients – with those put forward deemed appropriate for DCA (and by implication also considered ‘reasonable’ candidates for revascularisation). The

First, there is a much higher incidence of comorbidities in the elderly, which increases the potential for complications and may limit the scope for symptomatic improvement. For example, there may be little point in treating exertional angina when the patient is more limited by an arthritic knee. Second, care needs to be exercised when considering the benefits of prognostic interventions in a group that statistically have a relatively short remaining lifespan. These concerns emphasise the importance of studies specifically examining the response of the elderly to cardiovascular treatments – historically an area that has been overlooked. We

Introduction Over the last several years, the UK has witnessed a gradual ageing of its population.1 Moreover, the proportion of the very elderly (≥85 years old) in the general population is expected to rise fastest with a three-fold increase by the year 2035.1 Advancing age is perhaps the strongest predictor of de novo cardiovascular disease (CVD).2 As a consequence, cardiovascular (CV) mortality rates demonstrate a linear association with increasing age beyond the seventh decade. For example, octogenarians have a 10-fold greater risk of developing CVD in comparison with patients <50 years of age.2 Furthermore, mortality rates from CVD a

NICE updates A new ‘Evidence Update’ has been produced by the National Institute for Health and Clinical Excellence (NICE), which summarises selected new evidence relevant to the NICE guideline on the management of chronic heart failure (CHF) in adults in primary and secondary care (clinical guideline 108).NICE says “Whilst Evidence Updates do not replace current accredited guidance, they do highlight new evidence that might generate a future changes in practice.”  It says it will welcome feedback from societies and individuals in developing this service. The update is available from www.evidence.nhs.uk/evidence-update-2. New guides

Introduction Activated platelets play a pivotal role in the pathophysiology of acute coronary syndromes, and dual antiplatelet therapy with both aspirin and clopidogrel has become one of the cornerstones of their treatment.1 Similarly, dual antiplatelet therapy is mandated following percutaneous coronary intervention (PCI) with stent insertion to prevent stent thrombosis.2 Recently, there has been considerable interest in the phenomenon of inter-patient variability of clopidogrel response (sometimes termed ‘clopidogrel resistance’)3 and, to a lesser degree, the variability of aspirin response. This has led to interest in tailoring the dos

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In 2008 there were 1.3 million members of the population of the UK above the age of 85 years.1 By 2033 this number is expected to more than double to 3.2 million.1 This would represent approximately 5% of the population. Given the marked prevalence of coronary disease in the elderly it is likely that in the future cardiologists will be treating an increasing number of octogenarians as part of their patient population. Despite this, there remains a reluctance to perform percutaneous coronary intervention (PCI) in this patient group. Cardiologists often opt for medical treatment, and perceive this to be an acceptable strategy given the co-mo

Introduction Approximately 77,000 percutaneous coronary interventions (PCI) and 25,000 coronary artery bypass grafting (CABG) surgeries are performed in the UK every year.1 Revascularisation strategies may vary between institutions, medical attendants, and based upon patients’ preferences. Anatomic considerations are also important, and lesion location, severity and extent may influence decisions on revascularisation. The multi-disciplinary team (MDT) approach provides clinicians with an opportunity for peer consultations and provides ‘best-practice’ treatment strategies after review of angiographic recordings. Our weekly MDT meetings a