ISCHAEMIC HEART DISEASE

Further evidence for the efficacy of primary PCI in the ‘real world’ ▸

To evaluate the outcome of different reperfusion strategies, the outcomes of 26 205 consecutive patients with ST-elevation MI (STEMI) from the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) database were studied retrospectively. Overall 7084 patients underwent primary PCI, 3078 had pre-hospital thrombolysis (PHT) and 16 043 had in-hospital thrombolysis (IHT); all patients included in the analysis had received reperfusion therapy within 15 hours of symptom onset. The main outcome measures studied were mortality, reinfarction and readmissions. At 30 days, primary PCI was associated with a lower mortality than both IHT (4.9% v 11.4%) and PHT (4.9% v 7.6%), and this benefit was sustained at 1-year follow-up. PHT predicted a lower mortality rate than IHT at 30 days (hazard ratio (HR) 0.87) and at 1 year (HR 0.84), but beyond 2 hours’ treatment delay the observed mortality reductions with PHT tended to decrease while the benefits with primary PCI remained regardless of time delay. Primary PCI was also associated with a shorter hospital stay and less reinfarction than either method of thrombolysis. Thus, in this unselected group of patients in a ‘real world’ setting, primary PCI compared favourably with both pre- and in-hospital thrombolysis and was associated with a reduction in duration of hospital stay, readmission, reinfarction and mortality.

Metabolic syndrome: one definition fits all ▸

There is still no consistent definition of the metabolic syndrome, which leads to inconsistencies in the association between this disorder and the risk of cardiovascular disease. To clarify this issue a meta-analysis was performed using the two main modern diagnostic definitions of metabolic syndrome as a benchmark: those of the World Health Organisation (WHO) and the National Cholesterol Education Program’s Adult Treatment Panel III (ATP III). Data from 21 prospective cohort studies over the last 40 years were reviewed. Only those meeting the WHO and ATP III …