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  1. Iqbal Malik, Editor

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ISCHAEMIC HEART DISEASE

Would you have off-pump surgery? ▸

To compare the clinical, angiographic, neurocognitive, and quality of life outcomes of off-pump coronary artery bypass surgery with conventional coronary artery bypass grafting (CABG) surgery using cardiopulmonary bypass, patients were randomised to conventional CABG surgery using cardiopulmonary bypass (n  =  84) or off-pump coronary artery bypass surgery (n  =  84), carried out by one surgeon. Angiographic examination was carried out at three months postoperatively. Neurocognitive tests were carried out at baseline and at six weeks and six months postoperatively. Graft patency was evaluated by angiography in 151 (89.9%) patients and was similar (about 93%) between the cardiopulmonary bypass and off-pump groups (risk difference −1%, 95% confidence interval (CI) −5% to 4%), with the off-pump group considered the treatment group. Patients in the off-pump group required fewer blood transfusions (1.7 units v 1.0 unit, p  =  0.02), shorter duration of mechanical ventilation (7.7 h v 3.9 h, p  =  0.03), and shorter hospital stay (10.8 days v 8.9 days). Scores for neurocognitive function showed a significant difference in three memory subtests at six weeks and two memory subtests at six months in favour of the off-pump group. Previous studies have been contradictory, but this suggests that there is benefit from the off-pump approach in the right hands.

Are there short term benefits from statin treatment following an ACS? ▸

Briel and colleagues looked at 12 statin trials involving 13 024 patients with acute coronary syndrome (ACS) and calculated the risk ratios for the combined end point of death, myocardial infarction (MI) and stroke. Compared with patients treated with control therapy, the risk ratio for the combined end point was 0.93 (p  =  0.39) at one month and 0.93 (p  =  0.30) in patients taking statins. There were no significant risk reductions from statins for total death, total MI, total stroke, cardiovascular death, fatal or non-fatal MI, or revascularisation procedures (percutaneous coronary intervention (PCI) …

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