ISCHAEMIC HEART DISEASE

Patients often discontinue cardiac medication within six months for no apparent reason ▸

In the GRACE registry, of 13 830 patients, discontinuation of treatment was observed at six month follow up in 8% of those taking aspirin on discharge, 12% of those taking β blockers, 20% of those taking angiotensin converting enzyme (ACE) inhibitors, and 13% of those taking statins. The reasons for this were not clear. Patients with hypertension were more likely than others to discontinue statins, while cardiologists appeared to get better compliance, at least for aspirin treatment.

Is stress echocardiography better than perfusion scanning? ▸

Dobutamine stress technetium 99m (^99mTc)-sestamibi SPECT and dobutamine stress echocardiography were undertaken in 301 patients who were unable to perform exercise tests. Outcomes during a mean (SD) follow up of 7.3 (2.8) years were overall death, cardiac death, non-fatal myocardial infarction, and late (> 60 days) coronary revascularisation. Abnormal myocardial perfusion was detected in 66% of patients (n  =  198), while 60% (n  =  182) had an abnormal stress echocardiogram; agreement was 82% (κ  =  0.62). During the follow up period, 100 deaths occurred, of which 43% were due to cardiac causes. Non-fatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularisation. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after …