ISCHAEMIC HEART DISEASE

Bivalirudin as an alternative to heparin and abciximab in PCI? ▸

Bivalirudin is a direct thrombin inhibitor that is being investigated as a potential replacement for heparin. The results of the REPLACE-2 (randomized evaluation in PCI linking Angiomax to reduced clinical events) trial last year demonstrated that at 30 days following percutaneous coronary intervention (PCI), intraprocedural administration of bivalirudin with a glycoprotein (Gp) IIb/IIIa antagonist provided similar protection from acute ischaemic events with fewer haemorrhagic complications than the combination of heparin and Gp IIb/IIIa inhibition. Follow up data reveal comparable rates of death (1.4% of patients in the heparin group v 1.0% of patients in the bivalirudin group; p  =  0.15), myocardial infarction (7.4% v 8.2%; p  =  0.24) and repeat revascularisation (11.4% v 12.1%; p  =  0.45) at six months. An ongoing large scale trial (acute catheterization and urgent intervention triage strategy (ACUITY)) is now testing the efficacy of bivalirudin with or without Gp IIb/IIIa blockade in high risk patients.

Magnesium prophylaxis reduces cardiac arrhythmias post-CABG, but not length of stay ▸

Previous data highlight the problems of post-coronary artery bypass graft (CABG) atrial fibrillation and other arrhythmias. Length of stay increases, and mortality may be affected. This study, a meta-analysis of 17 trials (n  =  2069 patients) showed serum magnesium concentration at 24 hours after surgery in the treatment group was significantly higher than that in the control group (weighted mean difference 0.45 mmol/l, 95% confidence interval (CI) 0.30 to 0.59 mmol/l; p < 0.001). Magnesium supplementation reduced the risk of supraventricular arrhythmias (relative risk (RR) 0.77, 95% CI 0.63 to 0.93; p  =  0.002) and ventricular arrhythmias (RR 0.52, 95% CI 0.31 to 0.87; p < 0.0001), but had no effect on the length of hospital stay (weighted mean difference −0.28 days, 95% CI −0.70 to 1.27 days; p  =  0.48), the incidence of perioperative myocardial infarction (RR 1.03, 95% CI 0.52 to 2.05; p  =  0.99), or mortality (RR …