Ischaemic heart disease

Invasive treatment of ACS is cost neutral

▸ It is now clear that invasive treatment for acute coronary syndromes (ACS) is clinically effective in most patients. However, this entails the use of catheterisation facilities and additional consumables. This study suggests that the cost of the invasive strategy, including the use of tirofiban, is US$6100 v $7200 for the conservative strategy at six months (confidence interval of difference −$2000 to +$78). The cost-per-life-year gained with the invasive strategy was $12700 (range $8400–$27800).

Aspirin restarted within 48 hours of bypass surgery saves lives

▸ In a follow up study of more than > 5000 patients with non-random allocation of aspirin use, during hospitalisation, 3.2% and 16.0% had non-fatal cardiac, cerebral, renal, or gastrointestinal ischaemic complications. Among those patients who received aspirin (up to 650 mg) within 48 hours after revascularisation, subsequent mortality was 1.3% (40 of 2999 patients), as compared with 4.0% among those who did not receive aspirin during this period (81 of 2023, p < 0.001). Aspirin treatment was associated with a 48% reduction in the incidence of myocardial infarction (2.8% v 5.4%, p < 0.001), a 50% reduction in the incidence of stroke (1.3% v 2.6%, p = 0.01), a 74% reduction in the incidence of renal failure (0.9% v 3.4%, p < 0.001), and a 62% reduction in the incidence of bowel infarction (0.3% v 0.8%, p = 0.01). Of course, this was not a randomised study, so there may have ben some bias in the groups.

Magnesium is dead MAGIC

▸ After initial optimism, magnesium has fallen out of favour in the treatment of ACS. The MAGIC study confirms that 24 hours of magnesium treatment produces no benefit in patients who are, or are not, eligible for reperfusion therapy. Overall mortality rate was 15.1% at 30 days …