JournalScan

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

iqbal malik

Editor, JournalScan

ISCHAEMIC HEART DISEASE

Off-pump CABG is quicker and safer? In nine experienced US hospitals, 680 off-pump coronary artery bypass graft (CABG) procedures were compared to 1733 standard procedures. After adjusting for patient characteristics and risk factors, including severity of coronary artery disease, left ventricular function, functional status, diabetes, renal function, peripheral vascular disease, age, and priority of surgery (elective, urgent, emergent), off-pump surgery was found to be associated with a highly significant reduction in complications (multivariable odds ratio (OR) 0.52, 95% confidence interval (CI) 0.38 to 0.70; p = 0.0001) and operative death (OR 0.56, 95% CI 0.32 to 0.93; p = 0.033). Off-pump surgery was also associated with significant reductions in operating theatre time and length of hospitalisation. The study was not powered to detect differences in individual complications.

 1 Plomondon ME, Cleveland JC, Ludwig ST, Grunwald GK, Kiefe CI, Grover FL, Shroyer AL. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes.

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Evidence supporting an invasive approach to treatment of acute coronary syndromes: In 2220 patients with unstable angina or non-ST elevation myocardial infarction an invasive strategy (routine catheterisation within 4–48 hours and revascularisation as appropriate) was compared to a more conservative strategy (catheterisation performed only if the patient had objective evidence of recurrent ischaemia or an abnormal stress test). All patients were treated with aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. The primary end point was a composite of death, non-fatal myocardial infarction, and rehospitalisation for an acute coronary syndrome at six months. At six months, the rate of the primary end point was 15.9% with the early invasive strategy versus 19.4% with the conservative strategy (OR 0.78; p = 0.025). The rate of death or non-fatal myocardial infarction at six months was similarly reduced (7.3% …