JournalScan

Please visit the Heart website (www.heartjnl.com) for links to these articles.

ISCHAEMIC HEART DISEASE

Older people seem at major risk of cognitive dysfunction after CABG: There is a risk of stroke after coronary bypass grafting (CABG), but also a risk of cognitive dysfunction. Newman and colleagues undertook detailed evaluation up to five years and found that over 50% of patients have a decline in cognitive function at discharge, and 24% have a decline at six months. Worryingly, the number rises again to 42% at five years compared to preoperatively. The effect was most dramatic in the over 70s. Part of the observed effect is an age related decline, and part was associated with any operation, but the concern remains that cardiopulmonary bypass and aortic manipulation have long term effects on the brain.

 1 Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med2001;344:395–402OpenUrlCrossRefPubMedWeb of Science.

Women who have had an MI at an early age remain at higher risk for at least two years:Women who have suffered a myocardial infarction (MI) before the age of 60 years do worse than age matched men, despite correction for MI characteristics, complications, risk factors, and co-morbidity. The exact cause is not clear.

 2 Vaccarino V, Krumholz HM, Yarzebski J, Gore JM, Goldberg RJ. Sex differences in 2-year mortality after hospital discharge for myocardial infarction Ann Intern Med 2001;134:173–81OpenUrlCrossRefPubMedWeb of Science.

Treat cardiogenic shock post-MI with early revascularisation: The SHOCK (should we emergently revascularise occluded coronaries for cardiogenic shock) trial has shown that at one year, early revascularisation leads to a survival benefit over standard care (survival 47%v 34%). Standard treatment included intra-aortic balloon pump (IABP) in …