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Please visit the Heart website (www.heartjnl.com) for links to these articles—many to full text.
ISCHAEMIC HEART DISEASE
The CURE for ACS?Presented at the American College of Cardiology, the CURE (clopidogrel in unstable angina to prevent recurrent events) trial showed increased minor bleeding from 8.6% to 15.2%, and major bleeding from 2.7% to 3.6%. However, the primary end point for death/myocardial infarction(MI)/cerebrovascular accident was reduced from 11.5% to 9.3% at one year follow up. So for one extra bleed, two cardiovascular events are prevented per 100 patients treated. The individual end points of death and stroke were not decreased. Perhaps clopidogrel should be reserved for the higher risk acute coronary syndrome in the first instance. Clopidogrel in unstable angina to prevent recurrent ischemic events (CURE). Salim Yusuf, American College of Cardiology, 50th Scientific Sessions, Orlando, Florida 2001. Watch out for artefact before diagnosing VT on a rhythm strip: “An asymptomatic patient with a previous MI has an ECG”. When shown an ECG rhythm strip with what looked like ventricular tachycardia (VT) and given this history, 94% of junior doctors and 58% of cardiologists failed to notice the normal QRS complexes that ran through it, confirming that the apparent VT was caused by an artefact. Electrophysiologists did better, but even 30% of them made the mistake. The worrying thing was that the incorrect diagnoses led to the suggestion of referral for invasive tests.
1 Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia.OpenUrlCrossRefPubMedWeb of Science.
Use amiodarone and β blockade to prevent AF post-CABG: Previous studies have shown the effectiveness of amiodarone in prevention of perioperative atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. These data are mainly on younger patients …
Footnotes
Journals scanned—American Journal of Medicine; American Journal of Physiology: Heart and Circulatory Physiology; Annals of Emergency Medicine; Annals of Thoracic Surgery; Annals of Internal Medicine; Archives of Internal Medicine; BMJ; Canadian Medical Association Journal; Chest; European Journal of Cardiothoracic Surgery; Lancet; JAMA; Journal of Clinical Investigation; Journal of Diabetes and its Complications; Journal of Immunology; Journal of Thoracic and Cardiovascular Surgery; Nature Medicine; New England Journal of Medicine; Pharmacoeconomics; Thorax. Reviewers—C Baker, E Barnes, V Bhatia, R Desilva, M Earley, K Fox, D Gorog, G Jenkins, R Kaprilian, A Kapur, M Khan, P Lambiese, V Markides, M Poullis, P Ramrakha, J Strange, B Wasan, H Walker.