ISCHAEMIC HEART DISEASE

Drug eluting stents and the treatment of in-stent restenosis ▸

With bare metal stents, restenosis can still occur in up to a third of cases. How can this be treated? After pre-treatment with 600 mg of clopidogrel for at least two hours before intervention, all patients were randomly assigned to one of three treatment groups: sirolimus stent, paclitaxel stent, or balloon angioplasty (100 patients in each group). The incidence of angiographic restenosis was 44.6% (41/92) in the balloon angioplasty group, 14.3% (13/91) in the sirolimus stent group (p < 0.001 v balloon angioplasty), and 21.7% (20/92) in the paclitaxel stent group (p  =  0.001 v balloon angioplasty). The incidence of target vessel revascularisation was 33.0% (33/100) in the balloon angioplasty group, 8.0% (8/100) in the sirolimus stent group (p  =  0.001 v balloon angioplasty), and 19.0% (19/100) in the paclitaxel stent group (p  =  0.02 v balloon angioplasty). The secondary analysis showed a trend towards a lower rate of angiographic restenosis (p  =  0.19) and a significantly lower rate of target vessel revascularisation (p  =  0.02) among sirolimus stent patients compared with paclitaxel stent patients.

GIK does not benefit STEMI ▸

A meta-analysis suggested the benefit of glucose–insulin–potassium (GIK) infusions. This randomised controlled trial conducted in 20 201 patients with ST elevation myocardial infarction (STEMI) who presented within 12 hours of symptom onset were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n  =  10 091) or to receive usual care alone (controls; n  =  10 110). At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.95 to 1.13; p  =  0.45). There were no significant differences in the rates of cardiac arrest, cardiogenic shock, or reinfarction. The rates of heart failure at seven days after randomisation were also similar between the groups. The lack of benefit of GIK …