Ischaemic heart disease

Folate as a way to reduce in-stent restenosis ▸ Plasma homocysteine has been recognised as an important cardiovascular risk factor. Several groups have found a link between homocysteine concentrations and angiographic restenosis within stents. A trial of 553 patients assigned to lowering of homocysteine with B12 (400 μg/day), folate (1 mg/day), and pyridoxine (10 mg/day) versus placebo suggests benefit at one year. The combined end point of death/myocardial infarction/repeat revascularisation showed a relative risk (RR) of 0.68 on treatment (15.4% v 22.8%; p = 0.03), primarily caused by a reduced rate of target lesion revascularisation (9.9% v 16.0%, RR 0.62, 95% confidence interval (CI) 0.40 to 0.97; p = 0.03).

CABG or PTCA for isolated proximal LAD lesions? ▸ With improvements in technology, coronary angioplasty (PTCA) can be safely done in many cases which would previously have required surgery. Minimally invasive left internal mammary artery (LIMA) grafting (MIBCAB) has also reduced the risks of coronary artery bypass grafting (CABG). In 220 patients randomised to either PTCA and stenting, or MIBCAB, the surprising fact was the rate of death/myocardial infarction/revascularisation at six months was as high as 15% in the surgery group. This was better than the 31% in the PTCA group (p = 0.02). High restenosis rates after stenting (29% v 8%, p = 0.003) were the problem; rates of death and myocardial infarction did not differ significantly between groups (3% in the stenting group and 6% in the surgery group, p = 0.50). The percentage of patients free from angina after six months was 79% in the surgery group, as compared …