ISCHAEMIC HEART DISEASE

Direct stent or plain old balloon for primary angioplasty? ▸ Two independent reviewers selected and extracted data from identified randomised trials of direct stenting or balloon angioplasty for acute myocardial infarction (MI). The outcomes were mortality at 30 days, 6 months, and 12 months; recurrent events; and bleeding. Nine trials with a total of 4433 patients fulfilled the inclusion criteria. The odds ratios for mortality after stenting as compared with balloon angioplasty were 1.17 (95% confidence interval (CI) 0.78 to 1.74) at 30 days and 1.09 (95% CI 0.80 to 1.50) at 12 months (p value for heterogeneity > 0.1 for each comparison). The odds ratios for reinfarction after stenting as compared with balloon angioplasty were 0.52 (95% CI 0.31 to 0.87) at 30 days and 0.67 (95% CI 0.45 to 0.99) at 12 months; for target vessel revascularisation, they were 0.46 (95% CI 0.34 to 0.61) at 30 days, and 0.48 (95% CI 0.39 to 0.59) at 12 months (p value for heterogeneity > 0.1 for all estimates with the exception of reinfarction at 12 months where p  =  0.08). The odds ratio for postinterventional bleeding complications after stenting as compared with balloon angioplasty was 1.34 (95% CI 0.95 to 1.88; p value for heterogeneity > 0.1). Compared with balloon angioplasty, primary stenting is not associated with lower mortality, but is associated with a lower risk of reinfarction and target vessel revascularisation. Part of the effect may have been due to the use of ticlopidine and clopidogrel in the stent arm, but this is not proven.

Folic acid fortification: does it reduce mortality? ▸ In 1998, the US Food and Drug Administration mandated the fortification of food products with folic acid. The effect of this rule on mortality associated with homocysteine concentrations in patients with coronary artery disease is …